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2. Juror Number*
4. Today's Date*
   Today's Date
6. Summoned Date*
   Summoned Date
8. Summoned Time*
   Summoned Time
10. First Name*
11. Last Name*
13. Address1*
15. Address2
17. City*
18. State*
19. Zip*
21. Phone Number*
23. Email*
25. Exemptions*

    By statute, the following persons, and no others, may claim an exemption from jury service if the person wishes to do so. If you have a legal exemption, which you desire to claim, select the appropriate statement.

    1. I am over 70 years of age, and I desire to be excused from service at this time.
    2. I am over 70 years of age, an I desire to have a permanent exemption from jury service.
    3. I have legal custody of a child or children under the age of 15 years, and if I serve on the jury it will necessitate leaving such child or children without adequate supervision.
    4. I am a student of a public or private secondary school
    5. I am the primary caretaker of a person who is unable to take care of himself/herself.
    6. I am not a citizen of the United States.
    7. I wish to reschedule ONE time.
    8. I no longer live in Watauga. See current address listed above.
27. Student Exemption

    If you are seeking a student exemption, list the school you are attending.

29. Signature*

    Under Penalty of Perjury, I certify the above is true and correct. ( A signature is acquired by typing your name above).

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

    This field is not part of the form submission.

33. Submit Submit and Print

* indicates a required field