Community Service Referral Letter printable pdf download

Community Service Referral Letter

COMMUNITY SERVICE REFERRAL LETTER

*Docket #: _____________________ *Name: ______________________________________

TO THE DEFENDANT:

COURT ORDERED COMMUNITY SERVICE HOURS MUST BE COMPLETED WITH

A 501(C)(3) NON-PROFIT ORGANIZATION. FOR-PROFIT ORGANIZATIONS DO

NOT QUALIFY. COMMUNITY SERVICE MAY NOT BE COMPLETED ONLINE.

To be completed by the community service organization:

NAME OF ORGANIZATION: ___________________________________________________

IRS 501(c)(3) Tax ID:___________________________________________________________

ADDRESS: ___________________________________________________________________

CONTACT PHONE NUMBER: __________________________________________________

This letter is to confirm that the above named person completed __________ hours of

community service on _____________________, 20_____.

*PRINT NAME OF SUPERVISOR: _____________________________________________

*SUPERVISOR SIGNATURE: _________________________________________________

IT IS THE DEFENDANT’S RESPONSIBILITY TO RETURN

THIS FORM TO THE COURT.

Thank you for your participation. Please call the court if you have any

questions about our community service program.

Revised: 3/24/15

Community Service Referral Letter