STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS STIPULATION SUPREME COURT SUPERIOR COURT WORKERS' COMPENSATION COURT FAMILY COURT DISTRICT COURT RHODE ISLAND TRAFFIC TRIBUNAL Providence/Bristol County or Sixth Division Washington County or Fourth Division Kent County or Third Division Newport County or Second Division Plaintiff Civil Action File Number or Summons Number Defendant In the above-entitled cause it is agreed that the following entry be made: _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ Attorney for the Plaintiff or the Plaintiff /s/ ___________________________________________ Rhode Island Bar Number: Address: Office Telephone Number: Date: /s/ ____________________________________________ Judicial Officer CC-3 (revised April 2015) American LegalNet, Inc. www.FormsWorkFlow.com Attorney for the Defendant or the Defendant /s/ ___________________________________________ Rhode Island Bar Number: Address: Office Telephone Number: Date: __________________________________________ Date STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS STIPULATION Plaintiff Civil Action File Number or Summons Number Defendant Continuation page if needed. _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ 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_______________________________________________________________________________________ CC-3 (revised April 2015) American LegalNet, Inc. www.FormsWorkFlow.com