Juror’s Notice of Hardship
The Tulalip
Tribal Court
6332 31
st
Ave NE, Suite B
Juror – Notice of Hardship Tulalip, WA 98271
2.0 02/01/18 Ph. (360) 716-4773 | Fax: (360) 716-0657
I, _________________________________, am unable to serve on a jury because:
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___________________________________________________________________
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Date: _____________ ________________________________________
Signature
Address: ________________________________
City: _____________ State: ___ Zip Code ______
Phone number: __________________________
1. Are you 18 years of age or older? ............................................................................................ □ Yes □ No
2. Are you a Tulalip Tribal member? ............................................................................................ □ Yes □ No
3. Are you related by blood, marriage or adoption to a Tulalip Tribal Member? ....................... □ Yes □ No
a. If Yes, how are you related? ___________________________________________________
4. Are you a member of a federally recognized tribe other than Tulalip? .................................. □ Yes □ No
a. If Yes, which Tribe? ___________________________________
5. Are you a resident of the Tulalip Reservation? ........................................................................ □ Yes
□ No
a. If Yes, for how long?____________
6. Are you an employee of the Tulalip Tribes? ............................................................................ □ Yes □ No
a. If Yes, have you been an employee for longer than one year from today’s date? ..... □ Yes □ No
Return completed questionnaire above to Tulalip Tribal Court
This request is [ ] Approved by the court
Disapproved because:
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_________________________________________________
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Dated this _____ day of ___________________, 20____.
______________________________
Hon. Judge
I, ____________________________, herby certify that I mailed a copy of this document to the above named Juror
to their address shown above on the _____ day of _______________________, 20____.
___________________________________________
Tulalip Tribal Court Specialist
17817(*.,
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