REQUEST FOR EXCUSE FROM JURY DUTY AGE

REQUEST FOR EXCUSE FROM JURY DUTY - AGE

FOR JUROR/PROSPECTIVE JUROR: ____________________________________________________

(Required)

9-DIGIT BARCODE PARTICIPANT NUMBER: ___________________________

(Required)

This request is in response to a SUMMONS, date which your service begins:_______________

Reason for Excuse Request:

[ ] I am over 70 years of age.

Date of Birth ________________

(Required)

PLEASE NOTE: If you are over 70 years of age, it is not necessary to list other factors such as medical issues, care of a spouse, vacation, etc. You ONLY need to submit your request based on your age.

You must also mail the bottom portion of the summons you received with this form to the address below.

Excuse requests cannot be accepted on the date you are scheduled to appear for jury duty. You should mail this form as soon as possible to U.S. District Court, 324 W. Market St., Greensboro, N.C., 27401 Attn: Jury.

If you are seeking excuse from a summons, you will be notified by e-mail or via the U.S. Postal Service of the Court's decision. Do not assume that you have been excused merely because you have submitted a request to be excused.

Additional Information:

_____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________

__________________________________ ___________________________________ _____________

Signature

Printed Name

Date

(Signature, Printed Name and Date required in order for your request to be considered.)

Reset Form

Print Form

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download