Affidavit for Excuse or Deferral from Jury Duty CHILD CARE GIVER - ExcelSHE

Affidavit for Excuse or Deferral from Jury Duty

CHILD CARE GIVER

________________________County, Georgia

Juror Name: (Print name) Juror Address:

Juror Telephone Number:

________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________

I hereby affirm that I am the primary care giver having active care and custody of a child(ren) six years of age or younger and that I have no reasonably available alternative child care and that I request to be excused or deferred from jury duty in accordance with O.C.G.A. ?15-12-1 (a) (3). This the _________ day of ___________________, 20_____.

Signature: ________________________

the ____ day of ______________, 20___ .

____________________________________ Notary Public My Commission Expires: ________________________

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