Disqualifications and Exemptions
Should your situation fit into one of these categories, please provide the information
on this part of the form that was sent to you, and also provide any additional
documents, i.e. a doctor’s statement or affidavit as required. Return the completed form and
any other documents in the self-addressed stamped envelope that was included in your summons
packet.
YOU ARE EXPECTED TO REPORT FOR JURY DUTY UNLESS THE JUDGE APPROVES OF YOUR DISQUALIFICATION
OR EXEMPTION PRIOR TO YOUR SCHEDULED APPEARANCE DATE. The Clerk of Court will notify
you by mail if you do not have to appear.
If you have further questions or concerns about jury service, you may read further under
Jury Duty or call the jury clerk at 467.8553. Please leave a message and your telephone call
will be promptly returned in the same business day. Clerk of Court business hours are
Monday – Friday, 8:30 a.m. – 5:00 p.m.
Sample Information Only.
Complete the form that was mailed to you and return in the self-addressed stamped envelope that was included in your summons packet.
DISQUALIFICATIONS
- I am not a U.S. citizen.
- I am not a resident of this county. (Note correct address above.)
- I cannot read, write, speak, or understand the English language.
Translator’s name and telephone #:
____________________________________________
- I have less than a sixth grade education or its equivalent.
- I have a mental or physical condition that prevents me from serving as a juror. (Doctor’s statement required)
- I have been convicted in a state or federal court of a crime that carries a sentence of more than one year of imprisonment and I have not been pardoned or given amnesty for that conviction.
List offenses, when and where convicted:
____________________________________________
- I am a clerk of court, deputy clerk of court, constable, sheriff, commissioned law enforcement officer, probate judge, county commissioner, magistrate, or county officer, or I am employed within the walls of a courthouse.
Occupation:
____________________________________________
- I have served on a circuit court jury within this calendar year.
Date of Service:
____________________________________________
EXEMPTIONS
- I am 65 years of age or older and wish to be excused. (If you do not wish to serve on a jury, you may telephone the clerk of court to be excused. Unless you are excused by the clerk of court prior to the term for which you are summoned, you must report for jury duty.)
- I am the primary caretaker of a disabled person or a person age 65 or older who cannot care for himself.***
- I have legal custody and duty of care of a child under the age of seven and I cannot provide adequate childcare while serving as a juror.***
- I am a guard, keeper, employee, or other officer at a state penitentiary.
- I have served on a circuit court jury during the previous two calendar years, or I have served on a grand jury during the previous four calendar years.
Date of Service: ______________________________
County: ______________________________________
Jury Type: ___Circuit Court __Grand Jury
- I am a student or a school employee and wish to be transferred to a later date that will not conflict with my school term.
Date Available for Service: ______________________________
(When you return this form, you must also send evidence of school enrollment or employment.)
***An affidavit (notarized statement) must be returned with this form attesting to the above statements.
