Fill and Sign the Family Court District Court Form

CC -3 (revised April 2015 ) STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS STIPULATION  SUPREME COURT  SUPERIOR COURT  FAMILY COURT  DISTRICT COURT  WORKERS’ COMPENSATION 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 Ci vil 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/ ___________________________________________ Attorney for the Defendant or the Defendant /s/ __________________________________ _________ Rhode Island Bar Number: Rhode Island Bar Number: Address: Address: Office Telephone Number: Office Telephone Number: Date: Date: /s/ ___________________________________ ___ ______ ________________ __________________________ Judicial Officer Date CC -3 (revised April 2015 ) STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS STIPULATION Plaintiff Civil Action File Number or Summons Number Defe ndant Continuation page if needed. _______________________________________________________________________________________ _______________________________________________________________________________________ _________________________________________ ______________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ ___________________________________ ____________________________________________________ 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