STATEMENT OF COURT SERVICE For use of this form, see DoD ...

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STATEMENT OF COURT SERVICE

For use of this form, see DoD 7000.14-R Volume 8 Chapter 5; the proponent agency is CERM-FC.

EMPLOYEE WILL COMPLETE ITEMS 1 THRU 4

1. EMPLOYEE'S NAME (Last, First MI)

2. DATE (YYYYMMDD)

3. ORGANIZATIONAL UNIT 5. NUMBER OF DAYS SERVED

4. TYPE OF SERVICE

a. WITNESS b. JUROR

COURT OFFICER WILL COMPLETE ITEMS 5 THRU 10

6. WITNESS / JUROR FEES PAID (if any)

7. MILEAGE PAID (if any)

8. DATES SERVED

a. DATE (YYYYMMDD)

WEEK ONE

b. TIME (from-to 0001-2400 hours)

c.

d.

DATE (YYYYMMDD)

TIME

WEEK TWO

(from-to 0001-2400 hours)

e.

DATES EXCUSED (YYYYMMDD, from - to)

9. NAME OF COURT 10a. NAME AND TITLE OF COURT OFFICER

b. DATE (YYYYMMDD)

c. SIGNATURE OF COURT OFFICER

ENG FORM 2944, 1 SEP 1958

PREVIOUS EDITIONS ARE OBSOLETE.

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