Fillable 12255 Jury Financial Hardship (NJ Judiciary)

Fill Online, Printable, Fillable, Blank 12255 Jury Financial Hardship (NJ Judiciary) Form

Use Fill to complete blank online NJ JUDICIARY (NJ) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

12255 Jury Financial Hardship (NJ Judiciary)

On average this form takes 5 minutes to complete

The 12255 Jury Financial Hardship (NJ Judiciary) form is 1 page long and contains:

  • 0 signatures
  • 2 check-boxes
  • 19 other fields

Country of origin: US
File type: PDF

U.S.A. forms for NJ Judiciary

BROWSE NJ JUDICIARY (NJ) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Revised: 01/2020, CN: 12255 page 1 of 2
New Jersey Judiciary
Certification in Support of Request to be
Excused from Jury Service Due to
Severe Financial Hardship
Name
County
Candidate ID
Phone
Email
Summons Date
I, , of full age, hereby certify the following:
This certification is made by me in support of my request to be excused from jury service on
(date) , in County.
New Jersey law permits an excuse from jury service based upon severe financial hardship, as follows:
Jury service will impose a severe financial hardship, which will compromise the juror’s ability to support
himself, herself, or dependents. In determining whether to excuse the prospective juror, the Assignment Judge
shall consider:
(a) the sources of the prospective juror’s household income; and
(b) the availability and extent of income reimbursement; and
(c) the expected length of service.
[N.J.S.A. § 2B:20-10(c)(2)]
As to part (a): How many people are in your household?
What was your gross household income during the prior year? $
As to part (b): Are you employed? full-time part-time unemployed
Will you be paid at all during jury service? Explain.
If No, please provide a letter from your employer stating you will not be paid for jury service.
As to part (c): If at all, how many day(s) could you report (or be on call) without a severe financial
hardship?
Explain why jury service would present a severe financial hardship, as defined by law:
I have read and understood the instructions on the following page.
I understand that I may be required to provide documentation for review in support of this request.
I hereby certify and say that the foregoing statements made by me are true. I am aware that if any of the
foregoing statements made by me are willfully false, I am subject to punishment.
Signature
Print Name
Save
Print
Clear
Revised: 01/2020, CN: 12255 page 2 of 2
Juror Financial Hardship Request Information
• Jury service is a civic responsibility, as well as an opportunity to participate in the court process.
If qualified, all persons should serve as jurors to ensure that juries reflect the community.
• A jury summons may be received at a time that is inconvenient, whether for financial or other
reasons. All persons summoned for jury service may be rescheduled once without explanation
and a second time upon request to the local jury management office.
• This form is designed for persons who are requesting to be excused from reporting at all –
meaning that to report or to be on call even briefly is a severe financial hardship.
• Even if you do not qualify to be excused prior to reporting for service, you may always request
an excuse if the anticipated length of a trial would create a severe financial hardship.
• A person requesting a pre-reporting excuse based upon severe financial hardship must be
prepared, upon request, to provide supporting documentation such as a prior year’s redacted tax
return or proof of eligibility for public assistance or Social Security Disability benefits.
Employed persons may also be required to provide a letter from their employer or official human
resources documentation regarding income reimbursement policy.
• Authority to excuse a juror on the basis of severe financial hardship is vested in the Assignment
Judge, and there is no single formula. For example, an unemployed person receiving public
assistance could be required to report if reporting does not compromise employment
opportunities. On the other hand, a juror with greater household income may be excused if
reporting would compromise the juror’s ability to provide for himself, herself, or dependents.
• Submitting the completed certification form is required but is only the first step in requesting an
excuse. The Assignment Judge may always request additional information and/or
documentation in support of any excuse request, including a request based upon severe
financial hardship.
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

12255 Jury Financial Hardship (NJ Judiciary)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 11 February 2022

Message

View Audit Log
Print With Audit Log
Duplicate Document