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2. Juror Number*
3. Today's Date*
   Today's Date
5. Summoned Time*
   Summoned Time
6. Summoned Date*
   Summoned Date
8. First Name*
9. Last Name*
11. Address*
13. City*
14. State*
15. Zip Code*
17. Phone Number*
18. Date of Birth*
    Date of Birth
20. Email*
22. Exemptions (Texas Government Code, Section 62.106)*

    By statue, the following persons, and no others, may claim an exemption from jury service if the person wishes to do so. If you have a legal exemption, which you desire to claim, select the appropriate statement:

    1. Is over 75 years of age.
    2. Has legal custody of a child younger than 12 years of age and the person's service on the jury requires leaving the child without adequate supervision.
    3. Is a student of a public or private secondary school.
    4. Is a person enrolled and in actual attendance at an institution of higher education.
    5. Is an officer or an employee of the Senate, the House of Representatives, or any department, commission, board, office, or any agency in the legislative branch of state government.
    6. Is summoned for service in a county with a population of at least 200,000, unless that county uses a jury plan under Section 62.011 and the period authorized under Section 62.011 (b) (5) exceeds two years, and the person has served as a petit juror in the county during the 24-month period preceding the date the person is to appear for jury service.
    7. Is the primary caretaker of a person who is unable to care for himself or herself.
    8. Except as provided by Subsection (b), is summoned for service in a county with a population of at least 250,000 and the person has served as a petit juror in the county during the three-year period preceding the date the person is to appear for jury service.
    9. Is a member of the United States military forces serving on active duty and deployed to a location away from the person's home station and out of the person's county of residence.
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25. Email address

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