Exempt From VRA Certif. IN THE DISTRICT COURT FOR THE STATE OF ALASKA FIRST JUDICIAL DISTRICT AT KETCHIKAN ( ) STATE OF ALASKA, ( ) CITY OF KETCHIKAN, Plaintiff, v. , Defendant. ) ) ) ) ) ) ) ) ) ) ) CASE NO. CR TO: Community Work Service Supervisor Please complete this form and return it to the court upon completion of community work service by the defendant. STATEMENT REGARDING COMMUNITY WORK SERVICE I certify that the above-named defendant has completed: hours of community work service. no community work service. Date Signature Print Name Agency RETURN THIS FORM TO: Ketchikan Trial Courts 415 Main Street Room 400 Ketchikan, AK 99901 I certify that on a copy of this statement of work completed was given to the defendant. Clerk: CR-776 KETCHIKAN (11/99)(cs) STATEMENT REGARDING COMMUNITY WORK SERVICE Address Phone American LegalNet, Inc. www.FormsWorkFlow.com AS 12.55.015(a)(6) AS 12.55.055