Form Center • Jury Summons Exemption or Disqualification For

Jury Summons Exemption or Disqualification Form

CITY OF VICTORIA MUNICIPAL COURT
Instructions: You must report for jury service unless you (1) claim an exemption; (2) are disqualified; or (3) choose to postpone your service.

To claim an Exemption: Circle the exemption(s) that you claim. Submit this request electronically to the City of Victoria Municipal Court Clerk’s Office seven days before your schedule date of service. NOTE: You do not have to claim an exemption and may instead choose to serve.

If you are Disqualified: Mark the qualification(s) that you do not meet. Submit this form electronically to the City of Victoria Municipal Court clerk’s office seven days before your schedule date of service. NOTE: If you claim to be disqualified because you are not a resident of this county, you may become ineligible to vote in this county. If you state that you are not a U.S. citizen, you will no longer be eligible to vote if you fail to provide proof of U.S. citizenship to your county voter registrar.

To Postpone or be Excused from Service: Submit your request electronically to the City of Victoria Municipal Court Clerk’s Office seven days before your schedule date of service before your scheduled date of service.

Questions or Special Accommodations: Please contact City of Victoria Municipal Court Clerk’s Office at (361) 485-3050 or courtclerk@victoriatx.gov
Date you are Summoned for Jury Service*
Date you are Summoned for Jury Service
Full Name*
Date of Birth*
Address*
City*
State*
Zip Code*
Phone Number*
E-mail address*
QUALIFICATIONS FOR JURY SERVICE (select if you do NOT qualify)
To serve as a juror you must meet the following qualifications:
1. be at least 18 years of age;
2. be a citizen of the United States, of this State, and a resident of the City of Victoria (Government Code, Section 62.501; specific to municipal courts);
3. be qualified under the Constitution and laws to vote in the county in which you are to serve as a juror (Note: you DO NOT have to be registered to vote to be qualified to vote);
4. be of sound mind and good moral character;
5. be able to read, write and communicate in English;
6. not have served as a juror for six days during the preceding three months in the municipal court, in the county court or during the preceding six months in the district court.
7. not have been convicted of a felony or any type of theft (including misdemeanor theft);
8. not be on probation or deferred adjudication for a felony or any type of theft;
9. not be under indictment or other legal accusation of a misdemeanor theft, felony theft, or any other felony charge;
EXEMPTIONS FROM JURY SERVICE (select if you are Exempt)
You may be excused from jury service if: (SELECT THE EXEMPTION YOU ARE CLAIMING):
1. you are over 75 years of age;
2. you have legal custody of a child or children younger than 12 years of age and service on the jury would require leaving the child or children without adequate supervision;
3. you are a student at a public or private high school;
4. you are enrolled and in actual attendance at a college or institute of higher education;
5. you are a member of the U.S. military forces serving on active duty and deployed to a location away from your home station and out of your county of residence.
6. you are an officer or an employee of the senate, the house of representatives, or any department, commission, board, office, or other agency in the legislative branch of state government;
7. you are the primary caretaker of an invalid unable to care for himself/herself (This exemption does not apply to health care workers);
Request if you need to be excused but you do not meet the requirements above:
Please be detailed and upload any supporting documentation.
Request if you need to be Postponed but do not meet the requirements above:
Please be detailed and upload any supporting documentation.
You must click the checkbox to indicated agreement*
1. I DO HEREBY CERTIFY UNDER PENALTY OF PERJURY THAT I AM EXEMPT / DISQUALIFIED AS INDICATED ABOVE.*
By submitting this form, you hereby swear and affirm that the information provided above is correct. *
Upon review of your request, Municipal Court will send you notification regarding whether your request was approved or denied by the Judge.

Please send notification by:
1. By e-mail
2. By phone
Signature*
Date*
Date
Upload proof of identification*
Please upload your Driver's License, Identification card, or other proof of identification. This request is mandatory.
Upload additional documentation (if applicable)
Please contact the court.
It is your responsibility to follow up with the court at 361-485-3050 or courtclerk@victoriatx.gov to verify receipt of your request.
Right to Reemployment:
A private employer may not terminate the employment of a permanent employee because the employee serves as a juror. An employee whose employment is terminated in violation of this section is entitled to return to the same employment that the employee held when summoned for jury service if the employee, as soon as practical after release from jury service, gives the employer actual notice that the employee intends to return. (Civil Practice and Remedies Code, Section 122.001).
Failure to Answer Summons and Provision of False Information:
A person who fails to comply with this summons, or who knowingly provides false information in a request for an exemption or to be excused from jury service, is subject to a contempt action punishable by a fine of not less than $100 nor more than $1,000 (Government Code, Section 62.0141). Additionally, a person shall be fined not less than $100 nor more than $500 if the person: (1) fails to attend court in obedience to this summons without reasonable excuse; or (2) files a false claim of exemption from jury service. (Government Code, Section 62.111; see also Code of Criminal Procedure, Article 35.01).