Affidavit for Exemption from Jury Duty for Physical or Mental Impairment [PDF]
- Fill In The Form.
- Write Your Juror Badge Number On The Top Right-hand Corner Of The Form.
- Sign The Form.
- Have The Form Notarized.
- ALL MEDICAL EXEMPTIONS MUST INCLUDE A LETTER OR STATEMENT FROM YOUR DOCTOR STATING AS TO WHY YOU ARE UNABLE TO SERVE AS A JUROR.
Inability To Comprehend English
Affidavit for Exemption from Jury Duty for Inability to Comprehend English [PDF]
- The form must be translated and filled out by someone who understands and writes English.
- The translator must fill in the form.
- Write your juror badge number on the top right-hand corner of the form.
- The translator must sign and print their name on the form.
- The form must be notarized.
Mail or Fax Form to:
Annie Rebecca Elliott, District Clerk
Attn: Jury Duty
Richmond Texas 77469
- You are over 70 years of age
- You are over 70 years of age and claim a permanent exemption
- You have legal custody of a child or children younger than 12 years of age and service on the jury would require leaving the child or children without adequate supervision
- You are a student of a public or private high school
- You are enrolled and attend college
- You are an officer or employee of the senate, the house of representatives, or any department, commission, board, office or other agency in the legislative branch of state government
- You are a firefighter, including a fire chief, who is a permanent, paid employee of the fire department of a municipality or county or of a special district or authority that provides firefighting service
- You are a police officer, including a police chief, who is a permanent, paid employee of the police department of a municipality or county
- You are the primary caretaker of a person who is an invalid unable to care for himself or herself (This exemption does not apply to health care workers.)
- You have been summoned for service in a county with a population of at least 250,000 and you have served as a petit juror in the county during the three-year period preceding the date you are to appear for jury service.
- You are a member of the United States military forces serving on active duty and deployed to a location away from your home station and out of your county of residence.
You may not serve on a petit jury, unless you are:
- At least 18 years of age
- Of sound mind and good moral character
- Able to read and write
- A citizen of the state and county in which you are to serve as a juror, qualified to vote in the county in which you are to serve as a juror
You may not serve on a petit jury if you:
- Have served as a juror for six days during the preceding six months in District Court, or the preceding three months in County court or Justice courts.
- Have been convicted of a felony.
- Are under indictment or other legal accusation of a misdemeanor theft, felony theft or any other felony
- Are not a citizen of the United States (No soy ciudadano de Los Estados Unidos).
Do you have any questions? Call 281-341-4506 or email firstname.lastname@example.org.
** Please provide us your juror badge number when responding by e-mail. **