Jury Duty Excuse, Judge Chaney
Step 1 of 2: Submit
By submitting this form, I hereby swear or affirm to the Circuit Court that the matters and facts set forth herein are true and correct to the best of my knowledge.
Select an option:
Voter ID Number
Select an option:
Dist of Columbia
AGE STATUS, Over 65 and Willing to Serve on Jury
AGE EXEMPTION, Over age 65 and Request to be excused from jury duty.
PROVIDE DATE OF BIRTH IF CLAIMING AGE EXEMPTION
RECENT JURY SERVICE
I have served as a juror within the past two (2) years and request to be excused from jury duty.
FOR PRIOR SERVICE EXEMPTION - PROVIDE THE PRESIDING JUDGE AND APPROXIMATE DATE OF SERVICE
4. READING STATUS
I am unable to read and/or write without assistance from others.
I have been convicted of a felony.
FOR FELONY EXEMPTION - LIST CRIME, COURT OF CONVICTION, AND APPROXIMATE DATE OF CONVICTION
GAMBLER OR DRUNKARD
I am a common gambler or a habitual drunkard.
I am a full-time student and request to be excused from jury duty.
FOR STUDENT EXEMPTION - PLEASE IDENTIFY THE INSTITUTION YOU ATTEND
NON WARREN COUNTY RESIDENT
I currently reside outside of Warren County.
If claiming the non-resident exemption, you must contact the Warren County Circuit Clerk and be removed from the voting rolls.
BREASTFEEDING MOTHER or STAY-AT-HOME MOTHER
I am a breastfeeding mother or stay-at-home mother of children under the age of five (5).
INCAPABLE DUE TO ILLNESS
I am incapable of performing jury service due to illness.
If claiming this exemption, your treating physician must email (firstname.lastname@example.org) or fax (601.630.8033) a medical excuse.
EXTREME FINANCIAL HARDSHIP
If the conditions below apply, check here, AND PROVIDE THE REQUIRED DETAILS AND EXPLANATION.
Financial Hardship Exemptions
Jury service would cause undue or extreme financial hardship to myself.
Jury service would cause similar hardship to a person under my care or supervision.
11a. I would be required to abandon a person under my personal care or supervision due to the impossibility of obtaining an appropriate substitute.
11b. I would incur costs that would have a substantial adverse impact on my ability to pay for my necessary daily living expenses or for those whom I provide the principal means of support.
IMPORTANT: In the box below, describe your hardship in detail, place of employment, an estimate of funds you will lose by serving, and number of dependents. YOU CANNOT RECEIVE THIS EXEMPTION WITHOUT DETAILS.
REQUIRED DETAILS FOR FINANCIAL HARDSHIP EXEMPTIONS. NOT ALLOWED IF BLANK.
I am incapable of performing jury service due to circumstances related to COVID-19.
IF CLAIMING A COVID19 EXEMPTION, DESCRIBE YOUR SITUATION IN THE BOX BELOW USING THE OPTIONS GIVEN. YOU CANNOT RECEIVE THIS EXEMPTION WITHOUT A DETAILED EXPLANATION.
12a. Schools or daycares are closed so I need to care for my children.
12b. I have traveled internationally within the last fourteen (14) days.
12c. I have been in close contact with someone with a confirmed case of COVID-19 within the past 14 days.
12d. Myself or a member of my family falls into the category identified by the CDC as being high-risk for serious complications from the virus, including:
1.) Pregnant woman,
2.) Persons with compromised immune systems due to cancer, HIV, history of organ transplant or other medical conditions,
3.) Persons less than 60 years of age with underlying chronic conditions, or
4.) Persons over 65
REQUIRED DETAILS FOR COVID19 EXEMPTIONS. NOT ALLOWED IF BLANK.
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