Do I need a notary for the jury-duty medical exemption affidavit?

No. The form does not require notarization. The prospective juror signs and dates the affidavit, and a physician must complete and sign the attached statement.

How do I submit the jury-duty medical exemption affidavit?

Return the affidavit and physician’s statement to the Panola County District Clerk’s Office by mail, email at districtclerk@co.panola.tx.us, or fax at (903) 693-6914.

What must be attached to the affidavit?

A physician’s statement must be attached. The physician completes information about the applicant’s impairment and indicates whether the requested exemption is permanent or temporary.

Who completes the affidavit and physician’s statement?

The prospective juror completes the affidavit section, and the physician completes and signs the physician’s statement.

Panola County, TX · Panola County

No notary required

Affidavit for Exemption From Jury Duty for Physical or Mental Impairment

Prospective jurors seeking a medical exemption from jury duty in Panola County complete this affidavit and attach a physician’s statement.

At a glance

Issued by: City of Panola County · Panola County, Panola County, Texas
Notarization: Not required: file this form without a notary.
Official source: co.panola.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 prospective juror request a permanent or temporary jury-service exemption because of a physical or mental impairment. The prospective juror provides identifying and contact information, the requested exemption period, and the reason; a physician must complete and sign the attached statement. The court decides whether to grant the exemption after receiving both documents.

Who needs it

A prospective Panola County juror seeking a permanent or temporary jury-duty exemption for a physical or mental impairment needs this form and a physician’s statement.

How to submit it

Return the affidavit and physician’s statement to the Panola County District Clerk’s Office at 110 S. Sycamore St., Ste. 227, Carthage, TX 75633, by email at [email protected], or by fax at (903) 693-6914.

About notarization

This affidavit is signed and dated without a notary; a physician must complete and sign the attached physician’s statement.

How to submit this form

1
Download the Form
Download the Panola County affidavit and physician’s statement.
2
Complete the Affidavit
The prospective juror fills in the requested identifying, contact, and exemption information.
3
Get the Physician’s Statement
Have a physician complete and sign the statement, then attach it to the affidavit.
4
Return Both Documents
Send the affidavit and physician’s statement to the Panola County District Clerk’s Office by mail, email, or fax.

Frequently asked questions

Do I need a notary for the jury-duty medical exemption affidavit?: No. The form does not require notarization. The prospective juror signs and dates the affidavit, and a physician must complete and sign the attached statement.
How do I submit the jury-duty medical exemption affidavit?: Return the affidavit and physician’s statement to the Panola County District Clerk’s Office by mail, email at [email protected], or fax at (903) 693-6914.
What must be attached to the affidavit?: A physician’s statement must be attached. The physician completes information about the applicant’s impairment and indicates whether the requested exemption is permanent or temporary.
Who completes the affidavit and physician’s statement?: The prospective juror completes the affidavit section, and the physician completes and signs the physician’s statement.

Need something notarized?

This Affidavit for Exemption From Jury Duty for Physical or Mental Impairment doesn’t need a notary, but Texas residents can notarize other documents online with a commissioned online notary.