PASCOCLERK.COM - Jury Postponement Form

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Please provide the following information as it appears on your jury summons.

Fields marked with a single asterisk (*) are required to be completed. Fields marked with a double asterisk (**) one or more must be completed.

Please submit your request for postponement as soon as possible prior to your reporting date.

*LAST NAME:

*FIRST NAME:

*REPORT DATE:
mm/dd/yyyy

*JUDGE'S NAME:

*JUROR ID NUMBER:

**HOME TELEPHONE:
(999)123-4567

**BUSINESS TELEPHONE:(999)123-4567

**E-MAIL ADDRESS:

POSTPONEMENT OF SERVICE

If you need to reschedule jury service indicate in the space provided below any Monday date within 6 months of your original summons. For example, if you were originally summoned to appear for jury service in the month of June you cannot request a postponement date any later than the last week in December. ONLY ONE POSTPONEMENT IS ALLOWED, THEREFORE PLEASE SELECT A DATE THAT WILL BE THE MOST CONVENIENT FOR YOU.

I WISH TO RESCHEDULE MY JURY SERVICE TO THE DATE OF:

You will receive a reply ONLY if your request for postponement is denied.

COMMENTS (100 words or less)

By clicking the Submit Entry button, you are acknowledging that the above statements are true to the best of your knowlege and belief.