CONFIDENTIAL Superior-66 (revised May 2018) Page 1 of 3 STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS SUPERIOR COURT PETITION FOR EXTREME RISK PROTECTION ORDER Petitioner Civil Action File Number Respondent 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 - 4121 Licht Judicial Complex Providence/Bristol County 250 Benefit Street Providence, Rhode Island 02903 - 2719 *(401) 222 - 3230 Pursuant to title 8, chapter 8.3 of the General Laws of Rhode Island, the Petitioner requests that the court enter an extreme risk protection order. 1. Upon information and belief, the Respondent poses a significant danger of causing imminent personal injury to by purchasing, possessing, or receiving a firearm based upon the following grounds: . 2. A sworn affidavit is attached hereto in support of this Petition for Extreme Risk Protection Order. The Petitioner may produce sworn statements of other witnesses to support this petition. The affidavit(s) is attached hereto in support of this Petition for Extreme Risk Protection Order. American LegalNet, Inc. www.FormsWorkFlow.com CONFIDENTIAL Superior-66 (revised May 2018) Page 2 of 3 STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS SUPERIOR COURT 3. Pursuant to title 12, chapter 5 of the General Laws of Rhode Island, the Petitioner has concurrently filed a sworn affidavit for a search warrant for the search of any firearms in the possession, custody, or control of the Respondent. 4. I certify that to the best of my knowledge the Respondent is not in the military service as defined by the Servicemembers Civil Relief Act (50 U.S.C. 247247 3901, et seq.) and is not a member of the national guard on state active duty for a continuous period exceeding ninety (90) days as defined by G.L. 1956 247 30-7-10. 5. The following are all known restraining orders, orders of protection and pending lawsuits, complaints, petitions, or actions pending, active or filed within one (1) year prior to the petition involving the Respondent, but not limited to, an order entered pursuant to title 8, chapter 8.1 or title 15, chapter 15 of the Rhode Island General Laws: . 6. The following is the number(s), type(s), and location(s) of all firearms in the . The Petitioner requests that the court possession, custody, or control any firearms and further enjoin the Respondent from purchasing, receiving, or attempting to purchase or receive any firearms while an order is in effect. I request that the above relief be ordered because it clearly appears from specific facts shown by affidavit and by this Petition that the Respondent poses a significant danger of causing imminent personal injury to self or others by having in the Respby purchasing, possessing, or receiving a firearm before notice can be served and a hearing had thereon. I understand that the courts will schedule a hearing no later than fourteen (14) days after such order is entered on the question of continuing such temporary order. American LegalNet, Inc. www.FormsWorkFlow.com CONFIDENTIAL Superior-66 (revised May 2018) Page 3 of 3 STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS SUPERIOR COURT Name of the Petitioner Signature of the Petitioner Date: ATTORNEY CERTIFICATE /s/ Attorney for the Petitioner Rhode Island Bar Number: Date: American LegalNet, Inc. www.FormsWorkFlow.com