AOC-343 Doc. Code: COP Rev. 2-08 Page 1 of 1 Commonwealth of Kentucky Court of Justice www.courts.ky.gov KRS 533.070 Case No._____________________ Court________________________ CertifiCate Of PerfOrmanCe Of COmmunity ServiCe County_______________________ This will certify that_______________________________________________________________________________ (Defendant's Name) has performed community service at the direction of___________________________________________as follows: (Court) 1. The nature of the supervised community service has been: _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 2. Such service has been performed at the following times: COLUMN I Date No. Hours Date COLUMN II No. Hours Date COLUMN III No. Hours Total Hours: ______________________________________________________________________________________ TOTAL COLUMNS I, II AND III:____________________ OR 3. Defendant failed to complete community service as court ordered. This will further certify that throughout the period of the defendant's community service this organization has at all times remained a public agency, non-profit corporation, or eleemosynary institution. Date:_______________________, 2______ _________________________________________________ Signature _________________________________________________ Title FOR COURT USE: Date:_______________________, 2______ _______________________________________________ Clerk By:_____________________________________________ Deputy Clerk American LegalNet, Inc. www.FormsWorkFlow.com