Lassen — Community Service Work Time Sheet & Instructions

Source: https://www.lassen.courts.ca.gov/system/files/local-forms/lsc-crim-200.pdf

LASSEN COUNTY SUPERIOR COURT 2610 Riverside Drive Susanville, CA 96130 (530) 251-8205 COMMUNITY SERVICE WORK TIME SHEET

Agency: Case Number: ___________________________________ Name: __________________________________________

Number of Hours: ________________________________ Due Date: _______________________________________

Telephone: Next Court Date: _________________________________

Supervisor # Hours Supervisor # Hours Supervisor # Hours Date Date Date Initials Worked Initials Worked Initials Worked

Subtotal Hours: Subtotal Hours: Subtotal Hours:

TOTAL HOURS: ________________

AGENCY WHERE WORK PERFORMED: Under penalty of perjury, I hereby certify that: 1. I worked the hours indicated above; and Notice to Agency: Imprint the agency seal or stamp in 2. When this work was performed, I was not the space below. employed by or affiliated with the agency. SIGN

DEFENDANT’S SIGNATURE

SIGN RETURN COMPLETED TIME SHEET TO THE COURT ON OR BEFORE THE DUE DATE SIGNATURE OF AUTHORIZED AGENCY REPRESENTATIVE PLEASE USE A SEPARATE TIME SHEET FOR EACH AGENCY DATE: ________________________________________

Form Adopted for Mandatory Use COMMUNITY SERVICE WORK TIME SHEET & INSTRUCTIONS Lassen Superior Court LSC-CRIM-200 [Rev Jan. 27, 2025] www.Lassen.Courts.CA.gov

LASSEN COUNTY SUPERIOR COURT Community Service Work Time Sheet Instructions 1. Complete Time Sheet Daily. The Community Service Work Time Sheet must be completed on a daily basis by the individual supervising your 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 on or after the date you signed your agreement and only at an agency listed in the Community Service Work / Volunteer Work Agencies provided to you by the court. 2. Out of County Service. If you would like to complete your community service work at an agency outside Lassen County, please ask the court for a list of approved agencies. 3. Get Agency Stamp and Authorized Signatures. When you have completed all the hours, 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 and signature. 4. Turn in Your Time Sheet. It is your responsibility to return the completed and signed time sheet to the court. It must be received by the court on or before the due date specified on the time sheet. Failure to return the completed, signed time sheet by the due date will result in your community service work hours automatically being converted back to a fine, due and payable immediately, as described in your community service work agreement.

You are required to return to Court on the date and time stated on page 1 of this form pertaining to the completion of your court ordered community service.

Failure to complete the community service as ordered and file the Community Service Work Time Sheet on or before the due date specified on page 1 of this form, or failure to appear in Court at your next court date as indicated on page 1 of this form may result in further fine, imprisonment, additional community service, revocation of any probationary term, or may result in an order revoking any stay of execution of any sentence previously ordered.

Form Adopted for Mandatory Use COMMUNITY SERVICE WORK TIME SHEET & INSTRUCTIONS Lassen Superior Court LSC-CRIM-200 [Rev Jan. 27, 2025] www.Lassen.Courts.CA.gov