Request for Juror Excuse Form

If you are claiming an exemption or excuse, this form must be submitted XX days prior to your service date. Your request must include a written explanation of the reason(s) you are requesting an excuse from jury service. The judge will rule on your request and notify you as soon as possible.

For additional information you may call the court at (419) 885-8985.

I request an excuse from jury service because: (check one)*

I moved from Lucas County
I have actually served within the past two years for two consecutive calendar weeks
I am over 75 years of age
The interest of the public will be materially injured by my attendance at the trial
My spouse or a near relative of myself or my spouse has recently died or is dangerously ill
I have been convicted of a felony offense which my conviction has not been reversed or annulled nor have my civil rights been restored
I am a member of a cloistered religious organization or an active member of a recognized Amish sect
Jury service would cause undue or extreme physical or financial hardship to myself or to a person(s) under the car or supervision of myself

* If you are physically unable to serve, please download this form and mail it in along with a doctor's note.

Please further explain your reasoning for requesting exemption from jury service:*

Jury Group Number*

Your Name:*

First Last

Address*

Street Address City ZIP Code

Phone number*

Email address*

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