Community Service Confirmation - Verification Form
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1MUNICIPAL DIVISION
CITY OF COLUMBIA, Plaintiff
Case Number(s)______________
VS.
____________________________, Defendant
____________________________
Home Address
____________________________
________________________
City, State, Zip
Telephone #
COMMUNITY SERVICE CONFIRMATION
I, ___________________________________ of ______________________________________
(Name of Organization)
hereby confirm that the defendant named above has completed __________________ hours of
community service on ______________________________ as ordered by the City of Columbia
(Date or dates of Completion)
Municipal Court.
______________________________
Signature
______________________________
Date
______________________________
Title
______________________________
Phone
DEFENDANT MUST ASSURE THIS FORM IS RETURNED TO:
City of Columbia Municipal Court
600 E. Broadway
Columbia, MO 65201
573-874-7233
For additional confirmation forms go to:
ALL COMMUNITY SERVICE HOURS WILL BE CONFIRMED. ANY ATTEMPT TO
ALTER OR MIS-REPRESENT COMMUNITY SERVICE HOURS COMPLETED MAY
RESULT IN ADDITIONAL CHARGES BEING FILED.
Revised 05/10/2012
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