The purpose of this questionnaire is to identify jurors who have a reason recognized by law as making them presumptively unable to serve on a jury at this time. Please answer the questions completely and accurately.
Non-Pierce County residents require proof of change of address.
Medical reasons require a doctor's note if under the age of 80.
Please upload documentation supporting your reason that you are unable to serve.
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) 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 3) you may still be required to provide a traditional signature at a later date.
By signing above, I swear or affirm under penalty of law that I have truthfully answered these questions
This field is not part of the form submission.
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