CONFIDENTIAL FC-50 (revised November 2014) STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS FAMILY COURT AFFIDAVIT IN SUPPORT OF COMPLAINT FOR CIVIL PROTECTIVE ORDER WHEN EITHER PARTY IS A JUVENILE Plaintiff Civil Action File Number Defendant I, , on oath do depose and state as follows. Name of the Plaintiff or the Defendant Signature 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: American LegalNet, Inc. www.FormsWorkFlow.com CONFIDENTIAL FC-50 (revised November 2014) STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS FAMILY COURT AFFIDAVIT IN SUPPORT OF COMPLAINT FOR CIVIL PROTECTIVE ORDER WHEN EITHER PARTY IS A JUVENILE Plaintiff Civil Action File Number Defendant Continuation page if needed. American LegalNet, Inc. www.FormsWorkFlow.com