Stanislaus — Defendant declaration tr010

Source: https://www.stanislaus.courts.ca.gov/system/files/defendant_declaration_tr010.pdf

ATTORNEY OR PARTY WITHOUT ATTORNEY: FOR COURT USE ONLY Name: Address: Phone: ( ) SUPERIOR COURT OF CALIFORNIA, COUNTY OF STANISLAUS TRAFFIC DIVISION 2260 Floyd Avenue Modesto, CA 95355

PEOPLE OF THE STATE OF CALIFORNIA,
Plaintiff
vs.

_______________________________,
Defendant.

DEFENDANT’S DECLARATION AND CASE NO:
PROOF OF COMPLETION OF
COURT-ORDERED COMMUNITY SERVICE

INSTRUCTIONS:
1. Complete, date and sign this form as proof that you completed the required number of hours of court-
ordered community service.
2. Please attach a letter from the volunteer organization where you performed the community service. An
authorized representative of the organization must sign the letter and state the number of hours of community
service you performed. The letter must be on the organization’s letterhead stationery.
3. The court must receive the signed form and the organization’s letter on or before the completion date given
to you by the Judicial Officer or court clerk. If you are unable to complete your hours by the deadline, contact
the Traffic Court Clerk's office before your due date to see if you are eligible for a one-time extension.
1. Defendant’s Name: _______________________________________________________________
2. Name of Non-Profit Agency: ________________________________________________________
Street Address: __________________________________________________________________
City: __________________________________ State: ________ Zip Code: ________________
Phone: _______________________ Name of Supervisor: ________________________________
3. Number of Community Service Hours Performed: ____________
4. Date(s) Community Services Hours Performed: _________________________________________
________________________________________________________________________________
________________________________________________________________________________

I declare under penalty of perjury of the laws of the State of California that the information contained
in this form is true and correct, and I personally performed the required number of community service

hours set forth in item number 3 listed above.

Date: _______________________ Defendant’s Signature: _______________________________

Number of pages attached: ______

TR010 - DEFENDANT'S DECLARATION AND PROOF OF COMPLETION OF COURT-ORDERED COMMUNITY SERVICE New 3/29/2019