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Jury Duty Excusal Form
Please fill the form below
Name:
First Name
Last Name
This field is required.Please enter value
This field is required.Please enter value
Phone:
This field is required.Please enter value
Invalid phone number.
The value must be less than or equal to 20
EMail:
This field is required.Please enter value
Please enter valid email address
Section ID:
This field is required.Please enter value
Date Summoned:
This field is required.Please enter value
Date format is invalid, please check it again
The value must be greater than or equal to -21474836487
The value must be less than or equal to 2147483647
Disqualification:
I am not a U.S. citizen
I am a convicted felon whose civil rights have not been restored or I am under prosecution for a crime
I am the Governor, Lieutenant Governor, a Cabinet officer, a clerk of court, or a judge
I am exempt from jury service because I was summoned and I reported for jury duty within one (1) year prior to the reporting date listed on this summons
This field is required.Please enter value
Excusal:
I am over 70 years old and request excusal from this date only
I am over 70 years old and request permanent exemption from jury duty
I am an expectant mother
I am a parent who is not employed full time and have custody of a child under 6 years of age
I am a full time federal, state or local law enforcement officer or investigator
I am responsible for the care of someone mentally or physically unable to care for himself or herself (Please provide person's name in Comments area)
This field is required.Please enter value
Postponement (First Time Requests Only):
Reschedule within 30 days
Reschedule within 60 days
Reschedule within 90 days
This field is required.Please enter value
Comments:
This field is required.Please enter value
Submit
