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2. JURY ATTESTATION FORM - REQUEST TO BE EXCUSED FROM JURY SERVICE
4. Please select one of the following:*

   1. Puyallup Municipal Court Juror
   2. Milton Municipal Court Juror
6. Please Describe the Hardship or Reason you would like to be excused from Jury Duty*

   You can only be excused from jury duty for:

   • Medical reasons
   • Public necessity
   • Undue hardship
   • Dependent care
   • Student Status
   • Military conflict
   • Other reason deemed sufficient by the court

   For more information please go to the court's website by clicking the link below.  Thank you.

8. Jury Duty
   Jury Duty - Excusals
10. First Name*
11. Last Name*
13. Address*
15. City*
16. State*
17. Zip Code*
19. Phone Number*
20. Email Address*
22. Supporting documentation
    Please provide a letter from employer, doctor or other supporting documentation as to why you are unable to fulfill your Jury obligation:
23. Additional Upload
25. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
27. Electronic Signature*
28. Date*
    Date
30. COURT RESPONSE

    Thank you for contacting the court, the jury clerk will respond via email in 5-10 business days or before your jury term.

    
    

Leave This Blank:


32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit

* indicates a required field