Alachua County Jury Excusal Form

Please provide the following information:

First Name:
Last Name:
Report Date:
(Example: MM/DD/YY)
Juror Number:
 
Home Telephone:
(Example: XXX-XXX-XXXX)
Business Telephone:
(Example: XXX-XXX-XXXX)
E-mail Address:

Disqualification

Under Florida Statutes 40.013, you may not serve on a jury if any of the following reasons apply.  Please indicate if you:

Exemption

A citizen is not automatically disqualified from jury service for the reasons listed below, but may request to be exempted for any of the following:

A pregnant woman
Any person over 70 years of age
A person who has reported as a prospective juror for jury service in Alachua County within one (1) year from the prospective service month (federal jury service not included)
Cases of extreme hardship (please explain below)
A parent not employed full time, and having custody of a child under six (6) years of age
A care giver of a person with a mental or physical infirmity (please explain below - medical verification may be required)
A law enforcement officer (must have arresting powers)
An individual with significant physical or mental infirmity (please explain below)

Hardship

Your request must be approved by the Court.  Please explain the reason you are requesting to be excused or postponed (100 words or less).  Please note that the Court is only able to postpone jurors six months out from the original summons date.

Reasonable effort will be made to notify you if your request has been approved or denied via USPS mail. However, if you do not receive written or telephonic communication from this office, you must inquire by calling the Jury Information line at (352) 337-6238 three days prior to your report date as to your request or report on the assigned date of this summons.