Fillable Southern Ute Indian Tribe (SOUTHERN UTE INDIAN TRIBE)

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Southern Ute Indian Tribe (SOUTHERN UTE INDIAN TRIBE)

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SUIT Form #33 Request for Jury Duty Excusal
FCE__________
Southern Ute Indian Tribe
TRIBAL COURT
149 CR 517; P.O. Box 737 #18, Ignacio, CO 81137
Phone: (970) 563-0240 Fax: (970) 563-9570
REQUEST FOR EXEMPTION FROM JURY DUTY
I, Mr./Ms. , hereby respectfully request exemption
from Jury Duty for the following reason(s):
PLEASE ATTACH ANY SUPPORTING DOCUMENT PER THIS REQUEST
(Medical Release from Physician, Residency verification-utility bill, Travel Documents etc.)
Printed Name Date
Signature Telephone Contact Number
Mailing Address
City, State, Zip
THIS REQUEST IS:
GRANTED DENIED
DONE and DATED this ________ day of ___________________, 20_____.
Southern Ute Tribal Court Judge
I hereby certified that on this day of , 20___ the Juror was notified of
the decision of the Court via Phone United States Postal Service
Personal Delivery
Court Clerk Southern Ute Indian Tribal Court
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Southern Ute Indian Tribe (SOUTHERN UTE INDIAN TRIBE)

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Completed 20 July 2020

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