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AFFIDAVIT FOR PERSON 70 YEARS OF AGE OR OLDER EXEMPT FROM JURY SERVICE TO: Clerk of the Board Of Jury Commissioners I hereby request that my name be removed from the jury list under Georgia Laws 1985 Session Code Section 15-2-1 relating to exemption from Jury service for persons 70 years of age or older. In compliance with the law I submit to you the following affidavit. AFFIDAVIT Comes now, before the undersigned officer duly authorized to administer oaths, the Deponent who after being sworn states and affirms that he or she has attained the age of and wishes their name to be removed from the jury list and jury pool D.O.B. Signature Sworn to & subscribed Printed Name Before me this day of 20 Address City Notary Public (Seal must be affixed) Mail to: Clerk of the Board of Jury Commissioners c/o Judy Odom Clerk of Superior Court 65 Courthouse Street Blairsville, GA 30512