STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS DISTRICT COURT COMPLAINT FOR EVICTION FOR NON-PAYMENT OF RENT Plaintiff/Landlord Civil Action File Number Defendant/Tenant Attorney for the Plaintiff/Landlord or the Plaintiff/Landlord Address of the Plaintiff/Landlord's Attorney or the Plaintiff/Landlord Address of the Defendant/Tenant 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 1. The Plaintiff/Landlord is the owner of the rental premises listed above, in which the Defendant/Tenant currently resides. 2. The Defendant/Tenant is more than fifteen (15) days in arrears in rental payments due to the Plaintiff/Landlord from the Defendant/Tenant. The rent is $___________ per ______________, and the amount in arrears is $________________________, as of the ______________ day of _________________, 20_____. 3. The Plaintiff/Landlord has served the five-day demand notice as required by law, and a copy of that notice is attached to this Complaint. The notice was mailed to the Defendant/Tenant on the ___________ day of ________________________, 20__________. DC-54 (revised November 2014) Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS DISTRICT COURT 4. The Defendant/Tenant has not paid the rent in arrears or offered the full amount in arrears either before or after the demand notice. The Defendant/Tenant remains in possession of the rental premises. WHEREFORE, the Plaintiff/Landlord requests that this court grant a judgment for possession of the premise (eviction of the Defendant/Tenant) and for back rent in the amount of $________________, together with a fair rental value for use and occupation from the present until entry of judgment plus costs. /s/ _____________________________________________________________ Attorney for the Plaintiff/Landlord or the Plaintiff/Landlord Telephone Number: Rhode Island Bar Number: Date: DC-54 (revised November 2014) Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com