Juror Excusal Request printable pdf download

Juror Excusal Request

Return To:

[State Seal Here]

No later than 10 days before the

requested appearance date

This Space for Notary Office Use Only

Juror Excusal or Postponement Request

Juror Name:

Date:

Juror No.:

Case No.:

Court Location:

Appearance Date:

Excusal Request Due To:

(Please Check All the Boxes That Apply)

I am not a United States Citizen

I am currently being convicted of a felony

I am over the age of 70

I am a convicted felon w/o the return of my civil rights

I am under the age of 18

I am currently involved in another trial

I am pregnant

I have served as a juror in the past 24 months

I no longer live in this county

I cannot read or understand the English language

I am traveling abroad for more than 1 year

I am on active duty in the military

I am physically/medically incapable

I am an on-duty police officer

Elaboration/Details:

Postponement Request Due To:

(Please Check All the Boxes That Apply)

I am traveling at that time

I am caring for an ill friend/relative

I have business to attend to at that time

I am temporarily physically/medically incapable

I am a student and have exams at that time

I received my summons late

Elaboration/Details:

Requested Postponement Until:

I, the juror, hereby swear that the preceding information is correct and true to the best of my

knowledge. I understand that if I do not receive an excusal or postponement that I am

expected to arrive in court on the date requested.

Signature:

Date:

For Clerical Use Only

Juror Is:

Excused Due to:

Postponed Until:

Not Excused

Signature:

Date:

Juror Excusal Request

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