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2. Juror Information
4. First Name*
5. Last Name*
7. Email
8. Phone Number
10. Scheduled Appearance Date*
    Scheduled Appearance Date
11. Juror Number*
13. Please select from the following options*

    1. I am disqualified from serving
    2. I am exempt from serving

    1. I will attend
15. Qualifications for Jury service – To serve as a juror you must meet specific qualifications; please indicate by selecting which disqualifier applies to you if any. *

    1. I am not at least 18 years of age
    2. I am not a citizen of the state and resident of the county/city in which you are to serve as juror.
    3. I am not qualified under the Constitution and laws to vote in the county in which I am called to serve as a juror. (Note: you do not have to be registered to vote to be qualified to serve).
    4. I am not of sound mind and good moral character.
    5. I am not able to read and write.
    6. I have served as a juror for Six days during the preceding six months in the district court.
    7. I have been convicted of theft (misdemeanor or felony) or any felony.
    8. I am under indictment or other legal accusation of a misdemeanor theft, felony theft or any other felony charge.
    9. I am not resident of the municipality in which the court is established (Government Code, Section 62,501; specific to municipal courts).
17. Enter a forwarding address
19. Exemptions from Jury Service - You may be excused from jury service if one or more exemptions apply.*

    1. I am over 75 years of age.
    2. I have legal custody of a child or children younger than 12 years of age and service on the jury would require leaving the child or children without adequate supervision.
    3. I am a student at a public or private high school.
    4. I am enrolled and attend college or university.
    5. I am an officer or employee of the Senate, the House of Representatives, or any department, commission, board, or other agency in the legislative branch of state government.
    6. I am the primary caretaker of a person who is unable to care for himself or herself. (This exemption does not apply to health care workers.)
    7. I have served as a juror in the county during the 24-month period prior to the date required to appear for this summons
    8. I have been summoned for service in a county with a population of at least 250,000 and have served as a petit juror in the county during the three-year period preceding the date required to appear for
    9. I am a member of the U. S. military forces serving on active duty and deployed away to a location away from my home station and out of the county of my residence.
21. Enter Initials*
23. Upon form submission there is no further action required of you. A confirmation email will be sent to the email address you provide below. Please keep the email notification for your records.*

    1. I acknowledge
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25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit

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