Jury Commissioner & Jury Duty

2. REQUEST TO BE EXCUSED FROM JURY DUTY

4. Date listed on the Summons for the trial to begin.*
6. Name*
7. Phone Number*
8. Email Address*
10. Address*
11. City*
12. State*
13. Zip Code*
15. Reason you are requesting to be excused:*
17. Supporting Documents

    Travel plans, reservations, itinerary, doctor's note etc.

19. Dated*
    Dated
21. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
23. Electronic Signature*
Leave This Blank:


25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit

* indicates a required field