Jury Duty Deferral Request form template
Submit a request to defer or be excused from your scheduled jury service. Provide your juror summons number, select a qualifying hardship, and upload supporting documentation if required. The jury commissioner will review your request and notify you of the decision.
What’s in the box
Qualifying Reasons
Select from recognized hardship categories that may warrant a deferral.
Supporting Proof
Attach documentation such as a medical note or travel itinerary.
Sworn Statement
Sign an attestation affirming your stated reason is truthful.
Perfect for
- Postponing service due to a medical condition
- Requesting a new date for prepaid travel
- Excuse for primary caregiver duties
- Student deferral during exam period
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