原告：XXX，女 ，中国国籍，汉族 ，XXXX年XX月XX日出生，*********号码：，住址
谨代表， , 人,她居于该县并曾为该州定居居民且在提出该申请前已经居住满两年;并且，现为该州定居居民;并且，她于公元 年 月 日与 ,即其目前的丈夫结婚;婚后恪尽妇道履行婚约中的全部义务;但是， 却违背上述婚约义务;并且已出现导致婚姻不可挽救之破裂之不可调和的分歧。
本件于公元 年 月 日在 州 县本人面前签署并被宣誓保证为真实。
PETITION FOR DIVORCE
To the Family Court, next to be holden at Providence, within the County of Providence, on the first Monday of June A.D.19——.
Respectfully Represents, of Providence in the County of Providence that she resides in said County, and has been a domiciled inhabitant of said State and has resided therein for more than two years next before the preferring of this petition and is now a domiciled inhabitant of said State; that she was married to . Her present husband on the twenty-fifth say of September A.D.19——, and hath ever since on her part demeaned her self as a faithful wife and performed all the obligations of the marriage covenant; but that the said
hath violated the same on this; that
There are irreconcilable differences, which have caused the irremediable breakdown of the marriage.
Wherefore your petitioner prays that a decree of this Court may be made divorcing her from the bond of Marriage, and from the said .
Subscribed and sworn to before me at Providence in the County of Providence in said State of Rhode Island and Providence Plantations, this thirteenth day of may A.D.19——.
Justice of the Peace