Juror Hardship Request Form
Prospective Jurors: The law limits the grounds upon which the jury commissioner may excuse jurors from service based on a personal hardship. Prospective Juror asking to be excused from service due to a personal hardship must fill out and submit the form below. You will be advised of the court's decision after 5:00 PM the evening prior to your scheduled jury duty, when you call the designated number, or check the status in the on-line system as described in your summons.
Prospective Juror Name (last name, first name) *
Juror Identification Number *
Juror PIN *
Date of Scheduled Jury Service *
MM
/
DD
/
YYYY
Category of Hardship (check all that apply) *
Required
Describe the circumstances that qualify you for the above-selected hardship excuse: *
Juror Sworn Declaration: I declare under penalty of perjury that the above information is true. (Type your full name to so declare) *
Submit
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