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Lower Back of Your Summons

Back of Your Questionnaire

The back of the questionnaire must be filled out by all persons summoned to jury service. It tells us if you are qualified to serve as a juror, would like to request to be excused or postponed. Do not forget to complete the signature portion at the bottom.

Disqualification/Qualification

If you do not qualify to serve as a prospective trial juror, check the appropriate box, sign, date and write the city where executed.
Click here for more information on disqualification/qualification

Request for Excuse

If you would like to request an excuse from jury duty, read carefully and provide all requested information. Check the appropriate box, sign, date and write the city where executed. Click here for more information on requests for excuse.

Request for Postponement

If you would like to request a postponement, check this box and write the date that you are available.

You cannot have your service postponed for more than one year past your original service date. There is no jury service on weekends or Court Holidays.

If your current Group # is between 1000 and 4999, you are a Report-In Juror and must select a Monday through Thursday.

If your current Group # is between 5000 and 5999, you are a Call-In Juror. To remain a Call-In Juror, you must select a day that is a Friday. If you select another day of the week, you will become a Report-In Juror and will not be required to make any telephone calls prior to reporting.

Students and Teachers

Full-time students and teachers can postpone their jury service and serve during school breaks.

Signature

Remember: to sign your name, write the date and place you executed the affidavit. If you are completing the affidavit for another person, write your relationship to that person after your signature.

Exemption for Peace Officers

Peace Officers exempt under Code of Civil Procedure, Sec. 219 can check this box.