Community Service Verification Form - Kirkland Municipal Court Page 2
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1
2It is your responsibility to:
1. Contact the agency.
2. Perform the community service within the time limit set by the Court.
3. Submit a completed and signed Community Service Verification Form to the court.
4. Submit a letter of proof from the agency to the court. In order to be accepted by the Court
and/or Probation it must have the following:
Written/typed on agency letterhead
Letter must be dated
Include dates of service and actual hours service was performed
Include your case number
SAMPLE COMMUNITY SERVICE HOURS PROOF LETTER
December 15, 2012
Kirkland Parks Department
123 Fifth Avenue
Kirkland, WA 98033
This is to inform you that John Doe (case # 1Z0555555) completed 15 community service hours with the Kirkland
Parks Department in the month of October. Here is a log of the actual hours:
10/10
8:00-12:00
4 hours yard work
10/14
1:00-7:00
6 hours assisting with senior center event
10/17
8:00-12:00
8 hours yard work
Mr. Doe was a cheerful and reliable volunteer and we would welcome him back for future events. Should you
have any questions, please feel free to contact me at the phone number below or email me.
Jane Event
Volunteer Coordinator
Kirkland Parks Department
425 555 5555
JEvent@kirklandwa.gov
**Kirkland Court does not endorse any of these agencies; list provided for information only**
United Way King County
206-461-3655
HopeLink
425 889-7880
Humane Society
425-641-0080
Kirkland Parks Department
425-587-3012
Seattle YMCA
206-935-6000
Kirkland Boys & Girls Club
425-827-0132
(no DV cases)
Friends of Youth
425-869-6490
Washington Trails Association
206-625-1367
Eastside Community
425-825-1877
Aid Thrift Shop
Friends of the Trail
425-831-5486
U-District Food Bank
206-523-7060
Updated 7/23/15
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