PH:
740-687-6621
136 West Main Street
Post Office Box 2390
Lancaster, Ohio 43130
Daily Court Hours:
8:00am - 4:00pm
Monday-Friday
Valeda A. Slone - Clerk of Court
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Juror Information Sheet
First Name
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Last Name
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Street Address
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(Address Line 2)
City
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State
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Zip Code
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Juror Number
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Date of Birth
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Age
Daytime Phone
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Home Phone
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Email
Permission to notify electronically, if necessary?
Marital Status
Spouse's Name
Number of Children
Children's Ages (if under 18)
Your Employer
Duties of Employment
Spouse's Employer
Have you ever been a Defendant or Plaintiff in a civil or criminal action?
If yes, describe the nature of the case, when and where.
Are you related to any police officers or people in law enforcement?
If yes, please state their names and your relationship to each.
Have you ever served on a jury before?
If yes, when and where?
Have you, or members of your family, been involved in any criminal proceedings?
If yes, when and where?
Are you claiming an exemption from jury duty?
Request for Excuse from Jury Duty
If you are claiming an exemption, according to law as stated below, complete this information.
I claim exemption from jury service because:
Moved from Fairfield County
My new address is:
Physical inability to serve
Please describe physical inability:
Recent death or dangerous illness of my spouse or near relative
Please describe death or illness:
Material harm to the interests of the juror or public
Explain material harm:
Prior jury service within the past twelve (12) months
Please state when and where jury service was:
Member of a cloistered religious organization
Please explain:
Please enter vacation/out of town dates during the 3 month jury period (the Court will try to accommodate). If additional proof is needed, you will be notified by phone. If you are granted a partial excuse, you will be notified by mail:
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