MARIN COUNTY SUPERIOR COURT
P.O. Box 4988
San Rafael, CA 94913-4988
(415) 444-7180
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COMMUNITY SERVICE TIME SHEET |
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Agency: |
Docket # |
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Name |
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Address |
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City/State/Zip |
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Hours Assigned |
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Telephone: |
Work Completed/Time Sheet |
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Submitted to Court by |
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Supervisor |
# Hours |
Initials |
Worked |
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Supervisor |
# Hours |
Initials |
Worked |
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Total Hours: |
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_ |
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AGENCY WHERE WORK PERFORMED: |
Under penalty of perjury, I hereby certify that: |
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Notice to Agency: Imprint the agency seal or |
I worked the hours indicated above; and |
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stamp in the space below. |
When this work was performed, I was not |
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employed by the agency. |
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__________________________________________ |
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Defendant’s Signature |
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RETURN COMPLETED TIME SHEET TO: |
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___________________________________________ |
MARIN COUNTY SUPERIOR COURT |
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Signature of Authorized Agency Representative |
3501 CIVIC CENTER DRIVE, ROOM C-10 |
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P.O. BOX 4988 |
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Date: ______________________________________ |
SAN RAFAEL, CA 94913-4988 |
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PLEASE USE A SEPARATE TIME SHEET FOR EACH AGENCY |
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TR001 (I) (Rev. 1/12) |
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Page 1 of 2 |
COMMUNITY SERVICE ASSIGNMENT
TIME SHEET MAINTENANCE
1.The Community Service Time Sheet must be completed on a daily basis by the individual supervising the work by indicating the date, the number of hours worked and the supervisor’s initials in the space provided. Community service hours can only be performed after the date Court has assigned the number of hours to be completed and only at an agency listed in the Directory of Community Service Work Agencies as provided by the Court.
2.OUT OF COUNTY COMMUNITY SERVICE must follow the same instructions listed above but community service hours can only be performed at an agency that is listed in the California League of Alternative Service Programs Directory. The Court will provide the name of an agency that is acceptable.
3.When all the hours have been completed the time sheet must be imprinted with the agency’s stamp or seal in the space provided. The time sheet must also be signed and dated by an authorized agency representative. The Court will not accept the time sheet without the agency stamp or seal. The signed form must be received by the Court on or before the due date specified on the time sheet.
4.The Court will only accept the original time sheet, no copies. PLEASE USE A SEPARATE TIME SHEET
FOR EACH AGENCY.
5.It is your responsibility to return the completed time sheet to the Court as proof of completing the assigned hours and to pay the court imposed fees of $ ______________. Failure to pay the fees may result in the community service hours being converted to a fine.
TR001 (i) (Rev. 1/12) |
Page 2 of 2 |