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JURY SERVICE REQUEST TO BE DISQUALIFIED, POSTPONED, OR (Superior Court of the County of El Dorado)

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THE SUPERIOR COURT OF CALIFORNIA
COUNTY OF EL DORADO
JURY SERVICE REQUEST TO BE DISQUALIFIED, POSTPONED, OR EXCUSED
Local Form M-61 – Optional Use
New 05/29/20
Page 1 of 2
If you have received a summons to appear as a prospective juror at the El Dorado Superior Court (Court), you
are required to appear unless you are 1) not legally eligible to serve as a juror, 2) are granted a postponement
of jury service, or 3) are excused from jury service due to an undue hardship.
To request to be relieved from jury service, submit the completed form and proof of circumstances to:
Location
West Slope
South Lake Tahoe
Email
juryservices@eldoradocourt.org
juryservices@eldoradocourt.org
Mail
Office of the Jury Commissioner
3321 Cameron Park Drive
Cameron Park, CA 95682
Office of the Jury Commissioner
1354 Johnson Blvd.
South Lake Tahoe, CA 96150
Fax
(530) 672-2413
(530) 542-9102
Note: Requests must be submitted no later than NOON on Wednesday the week PRIOR to your appearance.
YOUR INFORMATION
First Name (Print):
Last Name (Print):
Badge Number:
REQUEST TO BE DISQUALIFIED
In accordance with California Code of Civil Procedure section 203(a), all persons are eligible to be prospective
jurors unless certain qualifications are not met. Complete the section below if you believe you do not meet the
qualifications to serve.
1) I AM NOT LEGALLY ELIGIBLE TO SERVE AS A JUROR BECAUSE (Check One):
1a. I am not able to read and understand the English language.
1b. I am not a citizen of the United States.
1c. I am not a resident of El Dorado County; I am a resident of .
1d. I am under the age of 18.
1e. I am now serving as a grand juror or trial juror.
1f. I have been convicted of a felony and I am currently on felony probation, parole, post release
community supervision, or mandatory supervision.
1g. I have been convicted of a felony and I am required to register as a sex offender.
1h. I am currently incarcerated.
1i. I have been convicted of malfeasance in office and my civil rights have not been restored.
1j. I am now under a court ordered conservatorship. My conservator is .
1k. I am now a peace officer as described in Penal Code sections 830.1 or 830.2(a). I am employed by
the following agency: .
Local Form M-61 – Optional Use
New 05/29/20
Page 2 of 2
REQUEST TO BE POSTPONED
If you cannot serve on your summoned date, generally you may reschedule your jury service one (1) time within
90 days of the original date you are summoned. Complete the section below if you want to postpone your service.
Proof of circumstances must be submitted with your request, when available.
2) I AM NOT AVAILABLE AS SCHEDULED BECAUSE (Check One):
2a. I have an employment conflict.
2b. I am a full-time student who will lose credit if absent (May postpone until the next school break).
2c. I am a teacher who is in session (May postpone until the next school break).
2d. I have a prepaid travel plans within the next 30 days.
2e. I am a breastfeeding mother (May postpone for up to one (1) year).
2f. Other (please explain):
I am available after (required):
Note: If you are not able to report to jury service once summoned after a one (1) time postponement has been
granted, you must immediately contact the Court (see page 1 for contact information).
REQUEST TO BE EXCUSED
California Code of Civil Procedure section 204(b) states that eligible persons may be excused from jury service
only for undue hardship. Complete the section below if you believe you have an undue hardship and need to be
excused from jury service. Proof of circumstances must be submitted with your request, when available.
3) I AM REQUESTING TO BE EXCUSED DUE TO UNDUE HARDSHIP BECAUSE (Check One):
3a. I have no reasonable means of travel by public or private transportation and the total travel time to
get to the courthouse exceeds one and a half hours (1.5 hours).
3b. I am experiencing an extreme and intolerable personal financial hardship (see instructions below).
▪ If employed, you must submit a letter from your employer confirming you will lose all wages, salary,
or commission during your service.
▪ If self-employed, you must submit an explanation of how jury service causes a loss of income
and/or hinders the operation of the business and why the loss cannot be avoided by postponing jury
service.
3c. I have a medical disability or scheduled operation/procedure (You must submit a statement from
your healthcare provider indicating you cannot serve on jury duty and the expected duration of disability).
3d. I am over the age of 70 and suffer from a permanent medical condition which would expose me to
an undue risk of physical or mental harm.
3e. My services are immediately needed for the protection for public health and safety and alternative
arrangements cannot be reasonably made (You must submit an explanation).
3f. I am the sole and indispensable caretaker for another person and comparable care is not
economically practical (You must submit verification of the need to provide care).
3g. I have served as a trial or grand juror in state of federal court within the past 12 months.
3h. I am actively serving in the military and stationed at (location)
until (date) (You must submit a copy of your military orders).
I declare under penalty of perjury under the laws of the State of California that the information I have
provided is true and correct.
_________________________ ____________________________________________________
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JURY SERVICE REQUEST TO BE DISQUALIFIED, POSTPONED, OR (Superior Court of the County of El Dorado)

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Completed 2 June 2021

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