Edit, Download, and Sign the Jury Duty Excuse Request Form for Seniors
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How do I fill this out?
To fill out this form, start by entering your 9-digit barcode participant number and the date your jury service begins. Next, indicate your date of birth and check the appropriate box if you are over 70. Finally, sign and date the form before submitting it to the court.

How to fill out the Jury Duty Excuse Request Form for Seniors?
1
Obtain the Jury Duty Excuse Request Form.
2
Fill in your 9-digit barcode participant number.
3
Enter the date your jury service begins.
4
Complete the date of birth section.
5
Sign and date the form before mailing it.
Who needs the Jury Duty Excuse Request Form for Seniors?
1
Individuals aged 70 and older who receive a jury summons.
2
Caregivers for seniors who cannot attend jury duty.
3
Anyone who is unable to serve due to age-related reasons.
4
People who wish to avoid disruption to their routine due to jury duty.
5
Those who want to ensure they have a valid reason to be excused.
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Make the necessary changes to the form or text.
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What are the instructions for submitting this form?
To submit the completed Jury Duty Excuse Request Form, mail it to the U.S. District Court at 324 W. Market St., Greensboro, N.C., 27401. Ensure that you include the bottom portion of the summons with your form. If required, you can also send the form by fax or check if online submission is available.
What are the important dates for this form in 2024 and 2025?
Important dates for submitting this form are typically aligned with your jury summons. Ensure you check the date indicated on your summons and plan to submit your request well in advance. Additionally, monitor any deadlines given in the correspondence from the court.

What is the purpose of this form?
The purpose of this form is to provide a means for seniors over the age of 70 to request an excuse from mandatory jury duty. It acknowledges the understanding that age-related issues may prevent individuals from serving on a jury. It aims to streamline the process for those who clearly qualify for an automatic exemption based on their age.

Tell me about this form and its components and fields line-by-line.

- 1. 9-Digit Barcode Participant Number: This is a unique identification number assigned to you for jury service.
- 2. Date of Birth: Your date of birth is required to verify your age for the exemption.
- 3. Signature: You must sign the form to validate your request.
- 4. Reason for Excuse: While primarily based on age, additional reasoning may be stated.
- 5. Printed Name: Include your printed name along with your signature for identification.
- 6. Date: The date on which you fill out and sign the form.
What happens if I fail to submit this form?
If you fail to submit this form, you may still be required to appear for jury duty. Failure to appear can result in legal consequences such as fines. It is crucial to act promptly upon receiving your jury summons.
- Legal Consequences: Not responding to your summons may result in penalties.
- Unsubstantiated Absence: You could be marked as a no-show if you don’t submit an excuse.
- Impact on Future Summons: Not addressing your jury duty may affect future summons.
How do I know when to use this form?

- 1. Age-Based Excusal: This form is for individuals 70 and older to request an exemption.
- 2. Caregiver Requests: Useful for caregivers seeking exemption due to their age.
- 3. Avoiding Disruption: For seniors who want to avoid jury duty interruptions.
Frequently Asked Questions
How do I request an excuse from jury duty?
Fill out the Jury Duty Excuse Request Form and submit it to the court.
What if I’m over 70 but have other reasons?
If you are over 70, you only need to submit your request based on your age.
How soon should I submit the form?
Send the form as soon as possible to avoid issues with your jury summons.
Can I edit the form online?
Yes, you can edit the form online using our PDF editor.
Do I need to sign the form?
Yes, a signature is required for your request to be considered.
How will I know if my request is accepted?
You will be notified by email or postal service regarding the court's decision.
What if I forget to mail the form?
Excuse requests cannot be accepted on the day you are scheduled to appear.
Where do I send the completed form?
Mail it to U.S. District Court at the specified address on the form.
Can my agent submit the form on my behalf?
You must submit the request unless you have a legal representative.
Is there a deadline for submitting the form?
Yes, submit it before your scheduled jury duty date.
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