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IN THE SUPERIOR COURT BLAIRSVILLE, UNION COUNTY, GEORGIA AFFIDAVIT FOR EXEMPTION FROM JURY DUTY (PRIMARY UNPAID CAREGIVER EXEMPTION) GEORGIA, UNION COUNTY JUROR JUROR I hereby affirm that I am the primary unpaid caregiver for a person with such physical or cognitive limitations that he/she can not be left alone. I have no reasonably available alternative to provide for that person’s care. Also attached is a statement of a physician, or other medical provider, supporting this affidavit’s statements related to the medical condition of the person with such physical or cognitive limitations. I request to be excused or deferred from jury duty in accordance with O.C.G.A. 15-12-1-(a)(5). This of Print Phone Subscribe and sworn before me This of Notary Public