Juror Exemption

PLEASE COMPLETELY FILL THE FOLLOWING SUMMONS FOR JURY SERVICE FOR EXEMPTION
Juror Number
Today's Date mm/dd/yy (example - 01/24/03)
Summoned Date mm/dd/yy (example - 01/24/03)
First Name
Last Name
Address 1
Address 2
City
State
Country
Phone
Email
  The following persons, by statute, AND NO OTHERS, MAY CLAIM AN Exemption from Jury Service if the person wishes to do so. If you have a legal EXEMPTION, which you desire to claim, pull the menu to the appropriate statement.
   
 


I am over seventy (70) years of age, and I desire to be excused from service at this time.

 I am over seventy (70) years of age, and I desire to have a PERMANENT EXEMPTION FROM JURY SERVICE.

I have legal custody of a child or children under the age of ten (10) years, and if I serve on the jury it will necessitate leaving such child or children without adequate supervision.

 I am a student of public or private secondary school.
( List the school attending: )

 I am the primary caretaker of a person who is an invalid and unable to care for himself/herself.

I am not a citizen of the United States.

Signature:


Under Penalty of Perjury, I certifiy the above is true and correct.
(A signature is acquired by typing your name below.)
I no longer live in the Town of Flower Mound. My current address is:




 

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