Who can claim a permanent jury-service exemption with this form?

The form says the claimant must be 75 or older and wish to claim a permanent exemption from jury service based on age.

What information does the form ask for?

It asks for your name, address, and date of birth, and includes a declaration of your age and desire to claim a permanent exemption, followed by signature and date lines.

Do I need a notary for the jury-service age exemption claim?

No. This form has signature and date lines but no notary block. The signer just signs and dates it; the document mentions no notarized or sworn attachment.

DeWitt County, TX · DeWitt County

No notary required

Claim for a Permanent Exemption for Jury Service Based on Age

DeWitt County residents age 75 or older use this form to claim a permanent exemption from jury service based on age.

At a glance

Issued by: City of DeWitt County · DeWitt County, DeWitt County, Texas
Notarization: Not required: file this form without a notary.
Official source: co.dewitt.tx.us
Blank form: Download the PDF
Catalogued: Oct 5, 2026
Machine-readable: JSON record · about the forms index

What this form is

This form lets a DeWitt County resident who is 75 or older claim a permanent exemption from jury service based on age. Complete it to state your name, address, and date of birth and to declare that you desire the exemption. The form is dated September 1, 2023, and directs the claimant to return it to the District Clerk.

Who needs it

A DeWitt County resident who is 75 or older and wishes to claim a permanent jury-service exemption based on age needs this form.

How to submit it

Return the completed form to Esther Ruiz, DeWitt County District Clerk, at 307 N. Gonzales St., Cuero, TX 77954, or to the District Clerk's Office on the courthouse's first floor.

About notarization

This document is signed and dated without a notary; it mentions no notarized or sworn attachment, so the signer just signs and dates it.

How to submit this form

1
Download the Form
Get the Claim for a Permanent Exemption for Jury Service Based on Age form.
2
Complete the Form
Enter your name, address, and date of birth, and complete the age-exemption declaration.
3
Sign and Date
Sign and date the form. It does not list an attachment to gather.
4
Return It to the District Clerk
Return the form to Esther Ruiz at the listed address or to the District Clerk's Office on the courthouse's first floor.

Frequently asked questions

Who can claim a permanent jury-service exemption with this form?: The form says the claimant must be 75 or older and wish to claim a permanent exemption from jury service based on age.
What information does the form ask for?: It asks for your name, address, and date of birth, and includes a declaration of your age and desire to claim a permanent exemption, followed by signature and date lines.
How do I submit the jury-service age exemption claim?: Return it to Esther Ruiz, DeWitt County District Clerk, at 307 N. Gonzales St., Cuero, TX 77954, or to the District Clerk's Office on the courthouse's first floor.
Do I need a notary for the jury-service age exemption claim?: No. This form has signature and date lines but no notary block. The signer just signs and dates it; the document mentions no notarized or sworn attachment.

Need something notarized?

This Claim for a Permanent Exemption for Jury Service Based on Age doesn’t need a notary, but Texas residents can notarize other documents online with a commissioned online notary.