Superior-63 (revised January 2019) STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS SUPERIOR COURT NO CONTACT ORDER State of Rhode Island v. Defendant Case Number Bureau of Criminal Identification Number Law Enforcement Agency Date of Birth Murray Judicial Complex Newport County 45 Washington Square Newport, Rhode Island 02840 - 2913 (401)841 - 8330 Noel Judicial Complex Kent County 222 Quaker Lane Warwick, Rhode Island 02886 - 0107 (401)822 - 6900 McGrath Judicial Complex Washington County 4800 Tower Hill Road Wakefield, Rhode Island 02879 - 2239 (401)782 - 412 1 Licht Judicial Complex Providence/Bristol County 250 Benefit Street Providence, Rhode Island 02903 - 2719 (401)458 - 323 0 It is hereby ORDERED that the above-named Defendant is enjoined and restrained from any contact with the alleged victim whose date of birth is . It is further ordered that the Defendant shall not harass, interfere with, molest, or threaten the victim in any manner, directly or indirectly. This Order is effective immediately and shall remain in effect until . A violation of this Order will subject the violator to possible arrest and further action by the court. A violation of the Order is a criminal offense under G.L. 1956 247 12-29-4 and will subject the violator to arrest. A violation of the Order is a criminal offense under G.L. 1956 247 12-29.1-5 and will subject the violator to arrest. A person subject to this Order who possesses, transports, or receives any firearms or ammunition may be subject to federal prosecution under 18 U.S.C. 247 922(G)(8), punishable by up to ten (10) years in prison. Signature of the Defendant Date Address: Entered as an Order of the court on . Judicial Officer Copy 1 Court Copy 2 Defendant Copy 3 Victim Copy 4 Police American LegalNet, Inc. www.FormsWorkFlow.com