City of Seabrook Forms

2. If you would like to request to be permanently excused from jury service in the City of Seabrook due to age, please complete and submit this form.

   G.C. 62.108, 109

4. FIRST NAME*
5. LAST NAME*
7. STREET ADDRESS*
9. MAILING ADDRESS

   If different from your street address

11. CITY*
12. STATE*
13. ZIP*
15. PHONE NUMBER*
16. EMAIL ADDRESS*
18. DATE OF BIRTH*
    DATE OF BIRTH
19. JUROR NUMBER*

21. Having been summoned as a juror in the Seabrook Municipal Court of Harris County, Texas, I request a PERMANENT exemption from jury service. I, the undersigned affiant, request that I be permanently excused from jury service in the City of Seabrook for the reason that I am over the age of 75 years old

23. SIGNATURE*
24. TODAY'S DATE*
    TODAY'S DATE
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26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit

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