Jury Service Affidavit

Please complete and submit the following information to be emailed to the Jury Coordinator.

Your Name: (As it appears on summons)
Summons Number:
Date of Service: (MM/dd/yyyy)
Street Address:
City:
State:
ZIP Code:
Email Address:
Phone Number:
 )   - 
I Hereby Declare:

Enter the code shown:

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