Legal Jury Excuse Letter

LEGAL JURY EXCUSE LETTER

To: Clerk of Court,   Juror Summons No.:   Summons Date:

Requestor Name:   Date of Birth:   Telephone:

Requestor Address:

RECITALS

WHEREAS, on the above-referenced court issued a jury summons to the Requestor identified above; and

WHEREAS, the Requestor asserts that service on the date(s) set forth would cause undue hardship, undue inconvenience, statutory disqualification, or other recognized grounds for excusal or postponement under applicable court rules; and

WHEREAS, the Requestor seeks an administrative determination by the Clerk or jury administrator to excuse or continue the Requestor's jury service for the reasons set forth below.

NOW THEREFORE, the Requestor respectfully submits this written Jury Excuse Letter and states as follows.

1. REQUEST FOR EXCUSAL OR POSTPONEMENT

The Requestor hereby requests that the Clerk grant: Excusal    Postponement to a later date    If postponement requested, preferred new date:

2. GROUNDS FOR EXCUSAL OR POSTPONEMENT

Select the basis for this request and provide a brief explanation where indicated:

Medical condition or disability requiring accommodation or ongoing treatment.

If medical, provide treating provider and brief description: ; Explanation:

Sole or primary caregiver for dependent with no reasonable alternate care.   If yes, name of dependent:

Employment hardship or essential duties causing substantial hardship if absent.   Employer:

Active military duty or training.   If military, provide commander/office:

Prior jury service within required period making me ineligible.   Date of prior service:

Financial hardship preventing attendance.

Other (explain):

3. SUPPORTING DOCUMENTATION

The Requestor will provide the following supporting documents with this letter (check those enclosed or to be delivered upon request):

Physician note or medical records    Employer letter confirming undue hardship or essential status    Military orders or official statement

Additional documents or explanation:

4. CERTIFICATION

I declare under penalty of perjury under the laws of the applicable jurisdiction that the foregoing is true and correct to the best of my knowledge. I further acknowledge that knowingly making a false statement for the purpose of avoiding jury service may subject me to penalties provided by law.

Requestor Contact Email:

5. RELIEF REQUESTED

Based on the facts stated herein and accompanying documentation, the Requestor respectfully requests that the Clerk grant an excusal from jury service or, in the alternative, a postponement to the preferred date listed above. If additional information or verification is required, please contact the Requestor at the contact information provided.

6. NOTICES

Any correspondence or determinations regarding this request should be sent to:

7. MISCELLANEOUS PROVISIONS

Governing Law: This request is governed by and shall be construed in accordance with the laws and rules applicable to jury administration in the jurisdiction of the above-named court.

Entire Agreement: This written letter, together with any attachments, constitutes the entire written request for excusal or postponement and supersedes prior oral or written communications on the subject.

Severability: If any provision of this letter is determined to be invalid or unenforceable, that determination shall not affect the remaining provisions, which shall remain in full force and effect.

Amendments and Waiver: Any amendment to or waiver of a provision of this request must be made in writing and signed by the Requestor and, where applicable, a certifying official.

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