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Juror Absence Request Form
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Name
*
Phone
Address
*
Occupation
Dear Judge of the Circuit Court for the City of Salem,
*
I am requesting that you excuse me from serving as a juror for the following dates and reasons(s).
I am requesting that you excuse me from serving as a juror for the entire term for the following reason(s).
Absence Days
*
Reason(s)
*
How would you like to be notified?
*
Email
Post Office Mail
Both Email and Post Office Mail
Email Address
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Electronic Signature (Please type your First and Last Name)
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Checking this box constitutes my legal signature.
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I understand
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