Jury Summons E-mail Form Excuse Affidavit
  1. If you claim an exemption because of illness to yourself or illness to another who would require your attendance, please return a doctors certificate so stating to the Clerk immediately. It will not be necessary that you appear. When the excuse is claimed because you attendance is required due to illness of another, every effort should be made to have someone else attend the person so that you can attend jury duty.
  2. If your attendance would require serious financial loss to yourself or your business, please complete the form below explaining this and submit it immediately with a telephone number and email address where you can be reached. You should not call the Clerk, and unless the Clerk notifies you that you are excused, it will be necessary that you appear at the time indicated on the summons or as per recorded instructions. You will be notified by email or phone if you are excused.
  3. If you are over 65 years of age or have served on the regular panel as a juror in Circuit Court in the actual trial of one or more cases within the last 2 years and do not wish to serve, so state on the form below and submit it immediately with a telephone number and email address where you can be contacted. It will not be necessary that you appear. You may serve if you desire. If there is a deficiency of jurors, the Clerk may notify you to appear.
  4. If you claim any other excuse due to emergency or hardship to yourself, please state your reasons on the form below and submit it immediately with a telephone number and email address where the Clerk can reach you. You should not call the Clerk, and unless you are notified by the Clerk that you are excused, it will be necessary that you appear as indicated.
Unless you are notified by the Clerk that you are excused, you must report for jury service. Failure to attend could result in a fine not exceeding $100.00 being accessed by the Court under section 13-5-34 of the Mississippi code of 1972.
STATE OF MISSISSIPPI

I, , first being duly sworn, state that I have been summoned for jury duty before the Circuit Court of , Mississippi on and that I do not wish to serve for the following reason:

Work Phone Number: Ext:
Home Phone Number:
Email Address:

By submitting this form you hereby swear or affirm to the Circuit Court that the matters and facts set forth above are true and correct to the best of your knowledge.