CONFIDENTIAL Superior-67 (revised May 2018) STATE OF RHODE ISLAND ANDPROVIDENCE PLANTATIONS SUPERIOR COURT AFFIDAVIT IN SUPPORT OF PETITION FOR EXTREME RISK PROTECTION ORDER Petitioner Civil Action File Number Respondent I, , on oath do depose and state as follows. Name of the Petitioner Date Signature State of County of On this day of , 20, before me, the undersigned notary public, personally appeared personally known to me or who proved to me through satisfactory evidence of identification, which was , to be the person who signed above in my presence, and who swore or affirmed to me 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