STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS DISTRICT COURT COMPLAINT AND MOTION FOR TEMPORARY RESTRAINING ORDER - TENANT AGAINST LANDLORD Plaintiff Defendant Address of the Defendant Civil Action File Number Attorney for the Plaintiff or the Plaintiff Address of the Plaintiff's Attorney or the Plaintiff Murray Judicial Complex 2nd Division District Court 45 Washington Square Newport, Rhode Island 02840-2913 (401) 841-8350 McGrath Judicial Complex 4th Division District Court 4800 Tower Hill Road Wakefield, Rhode Island 02879-2239 (401) 782-4131 Noel Judicial Complex 3rd Division District Court 222 Quaker Lane Warwick, Rhode Island 02886-0107 (401) 822-6750 Garrahy Judicial Complex 6th Division District Court One Dorrance Plaza Providence, Rhode Island 02903-2719 (401) 458-5400 Pursuant to G.L. 1956 §§ 34-18-6, 34-18-34, and/or 34-18-45, the Plaintiff hereby requests that this court enter a Temporary Restraining Order for the reasons set forth below. In support of this Complaint and Motion, the Plaintiff states: 1. The Plaintiff is the tenant of the rental premises located at: ________________________ ____________________________________________________________________________ 2. The Defendant is the landlord/owner of the property. 3. The Defendant has violated G.L. 1956 §§ 34-18-44 and/or 34-18-26 by doing one (1) or more of the following: The Defendant changed the locks to Plaintiff's apartment or otherwise excluded Plaintiff from the apartment. The Defendant shut off or otherwise interrupted Plaintiff's utility service, specifically: (Check as needed) Electricity Heat Gas Water Other: ___________________________ Page 1 of 3 DC-61 (revised November 2014) American LegalNet, Inc. www.FormsWorkFlow.com STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS DISTRICT COURT The Defendant has abused the right to reasonable access by entering the Plaintiff's apartment without giving the Plaintiff prior notice and without obtaining the Plaintiff's consent. 4. The Plaintiff has been harmed by these actions and will suffer irreparable harm if the court does not enter a Temporary Order as requested in this Motion and Complaint. 5. The Plaintiff contacted or attempted to contact the Defendant to tell the Defendant of this request for a Temporary Restraining Order by doing the following: _______________________ ______________________________________________________________________________ _____________________________________________________________________________. WHEREFORE, the Plaintiff asks this court to: 1. Enter a Temporary Restraining Order and Preliminary and Permanent Injunction, enjoining the Defendant to: Immediately give Plaintiff full access to and use of the rental premises and to return any property he/she may have removed from Plaintiff's apartment. Immediately restore all utility services that he/she terminated or interrupted. Cease and desist from entering Plaintiff's apartment without first giving Plaintiff proper notice and obtaining Plaintiff's prior consent except in case of emergency. and 2. Award the Plaintiff statutory damages as allowed by G.L. 1956 §§ 34-18-34 and/or 3418-45 and grant such further relief as this court deems fit and proper. I, _______________________________________, after being duly sworn, depose on oath and state that I am the Plaintiff in the above-entitled case, and I have personal knowledge of the matters to which the Complaint refers, and that these matters are true and correct to the best of my knowledge and belief. Name of the Plaintiff _____________________________________________________________________ Signature of the Plaintiff _____________________________________________________________________ Page 2 of 3 DC-61 (revised November 2014) American LegalNet, Inc. www.FormsWorkFlow.com STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS DISTRICT COURT State of _______________________________ County of _____________________________ On this ________ day of ________________, 20____, before me, the undersigned notary public, personally appeared _______________________________________________________ personally known to the notary or proved to the notary through satisfactory evidence of identification, which was _________________________________________________, to be the person who signed above in my presence, and who swore or affirmed to the notary that the contents of the document are truthful to the best of his or her knowledge. Notary Public: ____________________________________ My commission expires: ____________________________ Notary identification number: ________________________ ATTORNEY CERTIFICATE Rhode Island Bar Number: /s/ ______________________________________________________ Attorney for the Plaintiff Office Telephone Number: Date: Page 3 of 3 DC-61 (revised November 2014) American LegalNet, Inc. www.FormsWorkFlow.com STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS DISTRICT COURT TENANT RESTRAINING ORDER AGAINST LANDLORD - AFFIDAVIT Plaintiff Civil Action File Number Defendant I, ___________________________________________________, on oath do depose and state as follows. 1. My name is ______________________________________________________________ 2. I reside at _______________________________________________________________. 3. My landlord is ___________________________________________________________. 4. The following has occurred: _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ Name of the Plaintiff _____________________________________________________________________ Signature