To confirm the receipt of a summons for a jury trial, please complete the following:

1

Juror Number 

 *

Juror Number

2

Juror Last Name

 *

Juror Last Name

3

Juror First Name

Juror First Name

4

Jury Trial Date:

 *

Jury Trial Date:

5

Judge Name:

 *

Judge Name:

Leslie Halligan

Robert L. Deschamps, III

John W. Larson

Jason Marks

Shane A. Vannatta

Other (Please Indicate Judge Name on Summons) If other, type text here.

6

Phone Number:

 *

Phone Number:

7

Email (Optional):

Email (Optional):

8

Preferred Communication Method(s):

 *

Preferred Communication Method(s):

Phone

Email

9

If you feel like you need to be excused from this trial, please explain why in the space provided. The Judge will review your request and you will be notified of their decision using your preferred method from above.

If you feel like you need to be excused from this trial, please explain why in the space provided. The Judge will review your request and you will be notified of their decision using your preferred method from above.

While we encourage you to submit your request to be excused on this form, please be advised that the Judge will not approve your request if you do not have a current jury questionnaire on file with the Clerk of Court. If this information is missing from our records, we will contact you using your preferred method from above.

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1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

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