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 *
Category of Hardship (check all that apply) *
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) *
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy