Free IN THE DISTRICT COURT FOR THE STATE OF ALASKA - Alaska

Exempt From VRA Certif.

IN THE DISTRICT COURT FOR THE STATE OF ALASKA FIRST JUDICIAL DISTRICT AT PETERSBURG STATE OF ALASKA, Plaintiff, v. , Defendant, ) ) ) ) ) ) ) ) ) )

CASE NO.

CR

TO:

Community Work Service Supervisor Please complete this form and return it to the court upon completion of community work service by defendant. STATEMENT REGARDING COMMUNITY WORK SERVICE

I certify that the above-named defendant has completed: ______ hours of community work service. no community work service.

Date

Signature Print Name Agency

RETURN THIS FORM TO: Petersburg Trial Courts PO Box 1009 Petersburg, AK 99833 I certify that on a copy of this statement of work completed was given to the defendant. Clerk:
CR-776 PETE (5/97)(st.2) STATEMENT REGARDING COMMUNITY WORK SERVICE AS 12.55.015(a)(6) AS 12.550.055