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2. Juror Information
4. Juror Name
6. Email
7. Phone Number
9. Scheduled Appearance Date
   Scheduled Appearance Date
11. Exemptions from Jury Service

    You may be excused from jury service if one or more exemptions apply.

    1. I am over 70 years of age.
    2. I have legal custody of a child or children younger than 15 years of age and jury service would require leaving the child or children without adequate supervision.
    3. I am a student at a public or private high school.
    4. I am enrolled and attend college or university.
    5. I am an officer or employee of the Senate, the House of Representatives, or any department, commission, board, or other agency in the legislative branch of state government.
    6. I am the primary caretaker of a person who is an invalid and unable to care for himself or herself. (This exemption does not apply to health care workers.)
    7. I am a member of the U. S. military forces serving on active duty and deployed away to a location away from my home station and out of the county of my residence.
13. Enter Initials
14. Email Address
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16. 1. Receive an email copy of this form.
17. Email address

    This field is not part of the form submission.

18. Submit Submit and Print

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