Juror Response Form

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Juror Number *

First Name *

Last Name *

Address *

City *

State *

Zip Code *

Email *

Please choose one of the following: *

I will appear on the dates listed on the summons.

I request to defer my jury service to a different month (list month below)

I am not qualified to serve as a juror (choose reason below)

I request to be excused from jury service (please write excusal request below)

Deferral Month

If you are requesting a deferral, please list your preferred month (within the next six months):

Reason Not Qualified

RCW 2.36.070 states a person is competent to serve as a juror unless that person: (1) Is less than eighteen years of age; (2) Is not a citizen of the United States; (3) Is not a resident of the county in which they have been summoned to serve; (4) Is not able to communicate in the English language; or (5) Has been convicted of a felony and has not had their civil rights restored. Please choose the reason why you are not qualified to serve.

Excusal Request

Pursuant to RCW 2.36.100, excusal from jury service shall be limited and shall be allowed only upon showing of undue hardship, extreme inconvenience, public necessity, or any other reason deemed sufficient by the court for a period of time the court deems necessary. RCW 2.26.165: An employer shall provide an employee with sufficient leave of absence from work to serve as a juror when summoned. Please write your excusal request and reason below. Note: The court will email you if your request is denied.

I, THE UNDERSIGNED, DO HEREBY CERTIFY UNDER PENALTY OF PERJURY THAT THE ABOVE INFORMATION IS TRUE AND CORRECT

Electronic Signature *

Juror Response Form

Contact Information