Complaint Form For An Order Of Protection From Domestic Violence
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4STATE OF RHODE ISLAND AND
PROVIDENCE PLANTATIONS
FAMILY COURT
COMPLAINT FOR AN ORDER OF
PROTECTION FROM DOMESTIC VIOLENCE
Plaintiff
Civil Action File Number
Defendant
Murray Judicial Complex
Noel Judicial Complex
Newport County
Kent County
45 Washington Square
222 Quaker Lane
Newport, Rhode Island 02840-2913
Warwick, Rhode Island 02886-0107
(401) 841-8340
(401) 822-6725
McGrath Judicial Complex
Garrahy Judicial Complex
Washington County
Providence/Bristol County
4800 Tower Hill Road
One Dorrance Plaza
Wakefield, Rhode Island 02879-2239
Providence, Rhode Island 02903-2719
(401) 782-4111
(401) 458-3200
Pursuant to G.L. 1956 § 15-15-1, et seq., I request that the Family Court enter an order
protecting me and/or _________________________________________________ from abuse.
1. My name is____________________________________________________.
My present
address is _____________________________________________________________________
_____________________________________. My telephone number is ___________________.
2. My former residence, which I have left to avoid abuse, is ____________________________
_____________________________________________________________________________.
3. The name(s) and present address(es) of the person(s) causing the abuse are:
a. Name: __________________________________________________________________
b. Address: ________________________________________________________________
c. Telephone Number: _______________________________________________________
FC-53 (revised October 2014)
Page 1 of 4
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