Contact Information

Juror Number*

Report Date: mm/dd/yy*

Select any of the following options that apply

• If the date of your jury service is inconvenient, write a short statement in the box below indicating the reason you need to be postponed. In your statement you must request a specific Monday (that is not a holiday) within 6 months from the date you are scheduled to serve. Requested dates are usually accomodated.

• Expectant mother - Doctor's note required
• Parent not employed full time and who has custody of a child under 6 years of age -
        Must show proof of child's age (copy of birth certificate or shot records) and letter stating not
        employed full time
• Person 70 years of age or older
• Full time law enforcement officer/law enforcement investigative personnel - Need
        badge number and agency
• Caring for someone unable to care for self - Name of person, relationship to you, and nature
        of the person's illness or incapacity required
• Physically unable - Doctor's note required
• Reported for Jury Duty within one year
• Active Duty Military (where stationed and branch of service)
• Full-time student with proof (copy of student ID card or class schedule)

• Convicted Felon, civil rights not restored - Case number if known and/or State
• Under prosecution for a crime - Case number if known and/or State (where and when)
• No longer resides in Hernando County - Driver's license with new address required
• Not a U.S. citizen - Copy of Alien Card or VISA

• Excusal or Postponement - Fill in reason below:

After clicking the submit button, please wait while your form is being processed. If you do not see a confirmation page to print your request, your excusal will not be submitted.