Tom Green County, TX · Tom Green County
Request for Exemption from Jury Duty for Physical Impairment or Disability
Tom Green County jurors use this request to seek a permanent or temporary jury service exemption for a physical or mental impairment.
At a glance
- Issued by
- City of Tom Green County · Tom Green County, Tom Green County, Texas
- Notarization
- Not required: file this form without a notary.
- Official source
- tomgreencountytx.gov
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
What this form is
This form lets a prospective juror request a permanent or temporary exemption from jury service because of a physical or mental impairment. It asks for the juror’s contact details, the reason and duration of the requested exemption, and physician information. A physician must complete and sign the attached statement, which describes the impairment and how it affects jury service.
Who needs it
A prospective juror seeking a permanent or temporary exemption because an impairment makes jury service impossible or very difficult should submit this request.
How to submit it
Submit the request and completed physician’s statement to the Jury Administrator at 112 West Beauregard, San Angelo, TX 76903.
About notarization
This request is signed without a notary; the attached physician’s statement requires the physician’s signature, but the document does not call for notarization.
How to submit this form
- 1
Download the Request
Download the jury duty exemption request and physician’s statement.
- 2
Complete the Request
Enter the juror’s contact details, requested exemption duration, and reason for seeking an exemption.
- 3
Have the Physician Complete the Statement
Have the physician complete and sign the statement, including the impairment information and exemption length.
- 4
Submit Both Documents
Send the request and completed physician’s statement to the Jury Administrator at 112 West Beauregard, San Angelo, TX 76903.
Frequently asked questions
- Do I need a notary for this jury duty exemption request?
- No. The request does not call for notarization. The attached physician’s statement must be completed and signed by the physician.
- How do I submit the jury duty exemption request?
- Send the request with the completed physician’s statement to the Jury Administrator at 112 West Beauregard, San Angelo, TX 76903.
- What must the physician’s statement include?
- The physician provides their name, address, and phone number, certifies the person is under their care for an impairment, explains its effect on jury service, and indicates the exemption length.