Clerk of the Court

[Pages:1]UNITED STATES DISTRICT COURT

OFFICE OF THE CLERK

) (See address on reverse side

Dear Juror:

G We received a letter from

requesting that you be excused from jury service. Such requests must come from jurors themselves. If you wish to be relieved of this responsibility write a letter to this office requesting to be excused and setting forth your reasons. Your letter together with the letter from the above individual will then be submitted to the court for consideration. G In order to process your request for excuse from jury service we need a letter from your Doctor telling us whether or not you will be able to serve in the future. Please obtain such a letter and submit it promptly to this office.

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OFFICIAL BUSINESS PENALTY FOR PRIVATE USE $300

Clerk of the Court

AO 224 (Rev. 3/94) Request for Excuse -------------------------? --------------------------------------? ----------------------------------------------------------? ---------------------------------------------? ------------------------------? ----------------------------

UNITED STATES DISTRICT COURT

OFFICE OF THE CLERK

OFFICIAL BUSINESS PENALTY FOR PRIVATE USE $300

(See address on reverse side)

Dear Juror:

G We received a letter from

requesting that you be excused from jury service. Such requests must come from jurors themselves. If you wish to be relieved of this responsibility write a letter to this office requesting to be excused and setting forth your reasons. Your letter together with the letter from the above individual will then be submitted to the court for consideration.

G In order to process your request for excuse from jury service we need a letter from your Doctor telling us whether or not you will be able to serve in the future. Please obtain such a letter and submit it promptly to this office.

AO 224 (Rev. 3/94) Request for Excuse Print

Clerk of the Court

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