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2. Juror Reset / Exemption Request

   You may claim an exemption from jury service if the person wishes to do so. Proper documentation must be provided to the court 10 days prior to the scheduled trial date.

4. Juror Service Reset

   Please select this option if you wish to reset your juror service to a later date. By selecting this option, you understand that you will not be removed from the jury pool and will be selected for a later date.

   1. I wish to reset my juror service to a later date.
6. Please select one of the following exemptions:*
   -- Select One --Persons over 75 years of age (You do not have to claim an exemption and may instead choose to serve)Persons who have legal custody of a child(ren) under the age of 12 years if jury service would necessitate leaving the child(ren) without adequate supervisionAll students of a public or private secondary schoolEvery person who is enrolled in actual attendance at an institution of higher educationPersons who are the primary caretaker of a person who is unable to care for himself or herselfAn officer or an employee of the Senate, House of Representatives or any department, commission, board, office or other agency in the legislative branch of state governmentHe or she has served as a petit juror in the county during the 24 month period preceding the date he/she is to appear for jury serviceNo longer a resident of the City of Baytown State of TexasOther
7. Date of Birth*
   Date of Birth
9. If selected other, please explain:*
11. How many children? *
12. Child/Children Age(s)*
13. Is your child/children enrolled in school?*

    1. Yes
    2. No
15. First Name*
16. Last Name*
18. Juror Number*
19. Email Address*
21. Address*
23. City*
24. State*
25. Zip Code*
27. Phone Number*
29. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) the information you supplied is true and correct, 2) your request will not be signed in the sense of a traditional paper document, 3) 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 4) you may still be required to provide a traditional signature at a later date.

    1. I agree
31. Electronic Signature*
32. Date of Signing
    Date of Signing
Leave This Blank:


34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit

* indicates a required field