PROOF CR-775 (4/19)(cs) AS 04.16.205 STATEMENT OF COMMUNITY WORK (For Violation of Alcohol Possession Laws) Citation No. STATEMENT OF COMMUNITY WORK (For Violation of Alcohol Possession Laws) On , the attached citation was issued against me for possession of an alcoholic beverage in violation of Alaska Statute 04.11.501 or a city ordinance adopted under that statute. AS 04.16.205 allows me to perform community work as directed by the governing body of the community instead of paying the bail stated on the citation. The statute requires that I receive a credit of $5.00 per hour of community work against the bail amount. I have performed the following community work as directed by the governing body of the community: Dates of Work: Number of Hours Worked: Date Signature of Defendant Print Name of Defendant Mailing Address Phone STATEMENT OF REPRESENTATIVE OF GOVERNING BODY I confirm that the defendant named above performed community work as described above. Date Signature of Representative of Governing Body Print Name and Title ***************************************************************************** INSTRUCTIONS: You must send the original of this form to the magistrate or clerk of court at the court where the citation was filed within 30 days after you receive the citation. You must attach a copy of the citation on which you have checked the box indicating that you are pleading no contest. You may keep the yellow copy of this Statement of Community Work. "Community work" means and is limited to work on projects designed to reduce or eliminate environmental damage, protect the public health, or improve public land, forests, parks, roads, highways, facilities, or education; community work may not confer a private benefit on a person except as may be incidental to the public benefit. AS 04.21.080(b)(5) American LegalNet, Inc. www.FormsWorkFlow.com