Full Text
Affidavit for Excusal State of Montana I County of Big Horn (Print Name) declares: Affiant is informed of having been called as a trial juror in the District Court of the Bighorn County District Court of the State of Montana, to be held at Hardin, Montana. Affiant is applying for the following excusal and requests the Court's review: D PERMANIENT EXCLUSION - Must be chronically incapacitated by illness or injury (include Physician's certificatic D CHANGE [N RESIDENCE-Affiant no longer resides in County. D UNDUE l!IARDSHIP - Must state occupation and specific facts which Affiant believes constitutes undue hardship; having in mind jury service constitutes a duty of every competent citizen. Note: If tie Court denies your excuse for undue hardship, you may again submit a request if you are summoned for a trial. E: amples of potential undue hardships include military service, move, college, long-planned vacation, employm nt out of state, residence out of state, or other unusual personal circumstance. If you know you will be gone for i specific period of time, please list it here: I declare under penalty of perjury and the laws of the state of Montana that the foregoing is true and correct. Signature of Prospective Juror I APPROVED ~OT APPROVED COMMENTS: DATED this _-1---_day of , 20 District Court Judge