San Patricio County, TX · San Patricio County
Affidavit for Exemption From Jury Duty for Physical or Mental Impairment
Prospective jurors with a physical or mental impairment use this affidavit and attached physician’s statement to request a permanent or temporary jury-duty exemption.
At a glance
- Issued by
- City of San Patricio County · San Patricio County, San Patricio County, Texas
- Notarization
- Not required: file this form without a notary.
- Official source
- sanpatriciocountytx.gov
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
What this form is
This affidavit lets a prospective juror request a permanent or temporary exemption from jury service because of a physical or mental impairment. The county says the request requires an attached physician’s statement and is granted or denied by court order. The form asks for the applicant’s contact details, juror number, requested exemption period and reason, plus physician information and a statement about the impairment.
Who needs it
A prospective juror seeking a permanent or temporary jury-duty exemption because a physical or mental impairment makes jury service impossible or very difficult needs this form.
How to submit it
Complete the affidavit and physician’s statement, then return them to Jury Services for submission to the Court. The form lists the District Clerk’s Office at PO Box 1084, Sinton, TX 78387.
About notarization
This document does not require a notary; the applicant signs and dates the affidavit, and a physician completes and signs the attached statement.
How to submit this form
- 1
Download the Form
Download the jury-duty impairment exemption affidavit and physician’s statement.
- 2
Complete the Affidavit
Provide your contact information, juror number, requested exemption period, and reason for the request; sign and date the affidavit.
- 3
Get the Physician’s Statement
Have a physician complete and sign the statement describing the impairment and requested exemption duration.
- 4
Return the Documents
Return the completed affidavit and physician’s statement to Jury Services for submission to the Court.
Frequently asked questions
- Do I need a notary for the jury-duty impairment exemption affidavit?
- No. The applicant signs and dates the affidavit, and a physician completes and signs the attached statement.
- Who can request a jury-duty exemption with this form?
- A prospective juror may request a permanent or temporary exemption if a physical or mental impairment makes jury service impossible or very difficult.
- What must accompany the affidavit?
- A physician’s statement must be attached. It asks the physician to describe the impairment and indicate whether the requested exemption is permanent or temporary.
- How do I submit the jury-duty exemption form?
- Complete the affidavit and physician’s statement and return them to Jury Services for submission to the Court. The form lists the District Clerk’s Office at PO Box 1084, Sinton, TX 78387.