Jury Summons Response Form

For assistance completing the following Jury Summons Response form, please refer to the following links:

Juror Summons Form - front of page
Juror Summons Form - back of page

Jury Selection Date:
Select Month
Report Time

Section A

Are you qualified to serve as a juror?
If No


Section B

Are you asking to be excluded from jury service?
If Yes














Section C

Are you asking to be exempted from service based?
If Yes







By submitting this form, you certify that you are the person named in the Juror Summons, or you are authorized to respond on their behalf, and that the information submitted is true and correct to the best of your knowledge.