Domestic Violence Protection Order - Rhode Island

Before you use this: This proposed order is for court review and a judge's signature. A person requesting protection should use the Rhode Island Family Court's Form FC-79 for the complaint and temporary-order request. Complete only relief supported by the record and approved by the court.

STATE OF RHODE ISLAND

FAMILY COURT — [COUNTY]

Case No.: [CASE NUMBER]

DOMESTIC VIOLENCE PROTECTION ORDER

☐ Temporary ex parte order ☐ Order after hearing

Date of hearing, if held: [DATE]

Plaintiff appeared: [NAME / COUNSEL]. Defendant appeared: [NAME / COUNSEL / DID NOT APPEAR].

Findings

The Court reviewed the complaint, supporting affidavit, testimony, and other evidence identified here: [RECORD AND EXHIBITS].

Notice and service history: [HOW AND WHEN DEFENDANT WAS NOTIFIED OR WHY THIS IS AN EX PARTE ORDER].

The parties' relationship and persons to be protected are: [RELATIONSHIP AND NAMES OR INITIALS].

The Court finds the following facts supporting protection: [SPECIFIC ACTS, DATES, THREATS, INJURY, OR OTHER FINDINGS].

Based on those findings, the Court orders only the checked relief below.

Protective relief

☐ No contact. Defendant shall not contact Plaintiff or the following protected persons, directly or through another person, except as specifically allowed here: [NAMES / EXCEPTION, IF ANY].

☐ No abuse or harassment. Defendant shall not assault, molest, stalk, cyberstalk, harass, threaten, or otherwise interfere with the following protected persons: [NAMES].

☐ Stay away. Defendant shall remain [DISTANCE] from Plaintiff and these identified places or persons: [LOCATIONS / PERSONS]. The following exception, if any, applies: [EXCEPTION].

☐ Residence. Defendant shall vacate or remain out of the household at [ADDRESS] beginning [DATE AND TIME]. Defendant may retrieve personal belongings only as follows: [ARRANGEMENT APPROVED BY COURT].

☐ Utilities. Defendant shall not terminate or disrupt utility service at [RESIDENCE] without a further court order.

☐ Children. Plaintiff is awarded temporary custody of [CHILDREN] on these terms: [TERMS]. Contact or parenting time, if any, is limited to [SPECIFIC TERMS].

☐ Child support. Defendant shall pay [AMOUNT] to [RECIPIENT] by [METHOD] beginning [DATE] and ending [DATE OR FURTHER ORDER], subject to any separate support order identified here: [ORDER].

☐ Household animals. For the safety and welfare of household animals or pets, the Court orders: [ANIMALS AND PRECISE RELIEF].

☐ Firearms. Defendant shall surrender firearms to [RHODE ISLAND STATE POLICE / LOCAL POLICE DEPARTMENT / FEDERALLY LICENSED FIREARMS DEALER] by [COURT-SET DEADLINE]. Proof of surrender or a statement of no firearms shall be filed as the Court directs: [DETAILS].

☐ Other relief. [SPECIFIC RELIEF, FINDINGS, AND AUTHORITY APPROVED BY THE COURT].

Duration, hearing, and service

This order takes effect [DATE AND TIME] and expires [DATE AND TIME], unless changed by a later court order.

If this is a temporary ex parte order, the hearing on continuing relief is set for [DATE, TIME, AND LOCATION].

The Clerk shall provide copies to [RECIPIENTS]. Service on Defendant shall be completed by [AUTHORIZED SERVER AND METHOD]; the return of service shall be filed with the Court.

Any earlier order affected by this order is identified and treated as follows: [CASE NUMBER AND EFFECT].

SO ORDERED.

Date: [DATE] Time: [TIME]

Judge: [JUDGE NAME AND SIGNATURE]

Return of service

I, [SERVER NAME AND CAPACITY], served this order on [DEFENDANT NAME] on [DATE] at [TIME] by [METHOD AND LOCATION].

Server signature: [SIGNATURE] Date: [DATE]

Source

• Rhode Island Family Court, Form FC-79 (revised July 2025)