The Juror Qualification Questionnaire is a means to determine if a person is qualified to serve as a juror. If a person is selected to serve and receives a summons to report, he or she may ask to be excused at that time. There are limited permanent excuses that may be granted at the Questionnaire stage. If you fall under one of these categories and you wish to be excused, please fill in the bubble under question 14 and provide additional information on the back of your Questionnaire. GROUNDS FOR REQUESTING PERMANENT EXCUSE:

Persons over 70 years of age or older [you must provide date of birth];

Persons who have, within the past two years, served on a federal grand or petit jury panel (see 28 U.S.C.§1866(e)) [you must provide date served and court name];

Persons having active care and custody of a child or children under ten years of age [you must provide ages of child(ren)] whose health and/or safety would be jeopardized by their absence for jury service;

Voluntary safety personnel serving a public agency as a non-compensated firefighter or a member of an ambulance or rescue squad [you must provide name of agency and your position].