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Disqualification Request - Lake County Justice Center

STOP!- In order to qualify for a disqualification, you must meet one of the following criteria listed below. If you do NOT meet one of these criteria, you may apply for a postponement only.

Reason for Disqualification

I am not a Citizen of the United States.
I am not Eighteen years of age or older.

* NOTE: You must submit a birth certificate or state issued id via fax, mail, or email in order to be excused.

I am not a resident of Colorado and will NOT return to reside in Colorado in the next 12 months. You still qualifiy if you are traveling outside of the county.
The summons I have received is not from the county in which I reside.

* Please use the address fields below to update us with your current address and county information.

Inability to read, speak and understand the English language.
I am currently serving as a juror OR I have served as a selected juror within the preceeding twelve months OR I am scheduled for jury service within the next 12 months.

* You must submit a [document] via fax, mail, or email in order to be excused.

I have a serious physical or mental illness and would like to be excused.

* You must submit a doctor's statement via fax, mail, or email in order to be excused.

I have the sole responsibility for the daily care of a permanently disabled person living in the same household and do not work outside the home.

* You must submit a doctor's statement via fax, mail, or email in order to be excused.

I am breastfeeding a child and am temporarily unable to leave the child and would like to be excused.

* You must submit a medical statement via fax, mail, or email in order to be excused.

Comments:



County (as it appears on your summons - required)

View a sample jury summons Location (as it appears on your summons - required)

View a sample jury summons

Juror's Full Name (required)


Juror's Number (required)


Appearance Date (required)
Email Address (required)


Daytime Phone # (required)


Cell Phone #:

I live outside the United States.     This is a new address.

Current Address (required)


City (required)


State (required)
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P.O. Box / Apt #


County (required)
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By checking this box, I hereby certify under penalty of perjury that the above information is true and correct.