If you are asking to be excused from jury duty, please submit this form and documentation (if necessary). First and Last Name - As Listed on the Summons Current Name - If different from above Email Address Phone Number Reason for Request Supporting Documentation Certain requests to be excused from jury duty require documentation. Listed below are the required documents for some of the more common requests: 1. No longer live in the county - Proof of your new address 2. Medical - Note from your doctor's office 3. Full-Time Student - Proof of your class schedule 4. Non-Citizen - Proof of Green Card or other documentation Files must be less than 2 MB.Allowed file types: gif jpg jpeg png txt pdf.