IN THE TRIAL COURT - tribal justice
IN THE TRIAL COURT
OF THE CHEYENNE AND ARAPAHO TRIBES
700 Black Kettle Boulevard
P.O. Box 102
Concho, Oklahoma 73022-0102
COMMUNITY SERVICE HOURS
NAME: __________________________________ CASE NUMBER: _______________
ADDRESS: _____________________________________________________________
COM. SERVICE LOCATION: ______________________________________________
NUMBER HOURS ORDERED: _____________________________________________
TASKS PERFORMED: ____________________________________________________
SITE SUPERVISOR: _____________________________________________________
(Please Print)
Phone Number: _______________________________________________________
(Site Supervisor)
Site supervisor signature agreeing that the hours indicated below have been completed as scheduled and as requested.
_______________________________________ _______________________
Site Supervisor Signature Date
Date Time In Time Out Total Hours
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COMMENTS:____________________________________________________________
________________________________________________________________________
Return to Probation Officer when hours are completed & this form is signed.
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