COMMONWEALTH OF MASSACHUSETTS

______________SS:
     HOUSING COURT DEPARTMENT
                                                                                    ____________________ DIVISION
  

     

      CIVIL ACTION NO.
      /    /     /   -   /     /     /     /     /     /

_____________________________ PLAINTIFF(S)

VS.

  _____________________________ DEFENDANT(S)

VERIFIED COMPLAINT, and MOTIONS FOR TEMPORARY
RESTRAINING ORDER and PRELIMINARY INJUNCTION FOR
UNLAWFUL EVICTION, UTILITY TERMINATION OR
BREACH OF QUIET ENJOYMENT (G.L. c.  186, §14)

Part 1:   NAME OF PLAINTIFF(S) (the tenant): ___________________________________________

               ADDRESS (of apartment or rental house): _________________________________________

  ____________________________________________________________________________

  TELEPHONE NUMBER: ______________________________________________________

Part 2:   NAME OF DEFENDANT (the landlord): __________________________________________

  ADDRESS: __________________________________________________________________

  TELEPHONE NUMBER: ______________________________________________________

Part 3:   A.  On or about (date) ______________________________, the defendant (landlord):

G
               without judicial process.

  Locked me out of the premises or otherwise attempted to regain possession of the premises

G

G

  Turned off or failed to restore the utility service (heat, gas, electricity, hot water, water).

   Otherwise directly or indirectly interfered with my quiet enjoyment of the premises.

Specifically explain what happened:   (Use additional pages if necessary.)

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

-2-

B.

By engaging in the above acts, the defendant/landlord has cost me the following sums of money
(fill this in only if tenant wishes to claim specific money losses):

List of Expenses/Property Loss:

ITEM

AMOUNT

_______________________________________

$________________

_______________________________________

$________________

_______________________________________

$________________

_______________________________________

$________________

_______________________________________

$________________

_______________________________________

$________________

_______________________________________

$________________

+________________

TOTAL:

$________________

C:

My landlord is therefore liable to me for three (3) times the above amount or three (3) times
my monthly rent, $_________________ (enter amount) whichever is larger.  (G.L. c.  186,
§§14, 15F).

Part 4:   THEREFORE, I ask that the Court:

A.  Issue a Temporary Restraining Order, Preliminary Injunction, and Permanent Injunction
      restraining and enjoining the defendant from (check where appropriate):

________

Denying me possession of the premises;

________

Depriving me of utility service;

________

Denying me possession of my personal belongings;

________

Otherwise interfering with my right to quiet enjoyment of the premises.

B.  Award me money damages in the amount of $_____________ (the greater of three (3) 
     times monthly rent or actual damages) plus costs.

C.  Award such other relief as the Court deems appropriate.

D.  Issue a Short Order of Notice.

E.  Schedule a Preliminary Injunction Hearing prior to the expiration of any Temporary Restraining Order
that my be granted.

-3-

Respectfully submitted,

_________________________________
PLAINTIFF’S SIGNATURE

_________________________________
ADDRESS

_________________________________

_________________________________
Telephone

VERIFICATION

I, _______________________________, have personal knowledge of all of the facts stated above
and hereby swear under the pains and penalties of perjury that all of those facts are true and accurate.

_________________________________
DATE:

_______________________________________
SIGNATURE