Request for Undue Hardship | Kathryn Strong | Sumner County Circuit Court Clerk

Under Tennessee law, you may only be excused from jury duty if you have a disqualifying undue or extreme hardship as outlined in TCA 22-1-103. If you believe you qualify for excusal due to an undue or extreme hardship under the law, please complete the form below and provide the required information and documentation.

First and Last Name - As Listed on the Summons

Current Name - If different from above

Date of Birth

Address

City and Zip

Email Address

Phone Number

Reason for Request

Supporting Documentation

If requesting a medical hardship, you must attach the completed Health Related Request for Excuse form completed by your physician or your physician must submit the required documentation directly to our office.
Files must be less than 20 MB.
Allowed file types: gif jpg jpeg png txt rtf html pdf doc docx.

I, the undersigned prospective juror, do hereby request to be excused from jury service for the following reason(s):

I, the undersigned, hereby make oath or affirmation under penalty of perjury that the information provided is true and accurate to the best of my knowledge

Date