Jury Excuse Form

Jury Excuse Form
If you would like to be excused from jury duty please complete and submit appropriate documentation in one of the following manners:
Option one - Online submission (Complete this form)
Option two - Mail: Please Mail the completed form to
Judge M. James Chaney
P.O. Box 351
Vicksburg, MS. 39181
Option three - Fax: Please Fax the completed form to 601.330.8033
Questions: Please call the Court Administrator at 601.638.8981

Date(Required)

County(Required)

What is your county of residence

Summons Date:

Date your summons was issued.

Voter’s Registration Number(Required)

Home Phone

Home or Cell Phone

Date of Birth(Required)

If Claiming an exemption for being over 65 years old, please provide your Date of Birth

Jury Service within Last 2 Years:(Required)

Please provide the Judge who presided and approximate date of the Jury Duty you were on within the last two years,

Felony Conviction:(Required)

Please list the crime(s), court of conviction(s), and approximate date of conviction(s)

Full-time Student:(Required)

Please Identify the Institution you attend:

You must contact the Warren County Circuit Clerk and be removed from the voting rolls.

Detailed Explaination(Required)

Please give a detailed reason why this would create a financial hardship

1.) pregnant woman.
2.) Persons with compromiosed immune systemsdue to cancer, HIV, history of Organ transplant or other medical conditions
3.) Persons less than 65 years of age with underlying chronic conditionsor.
4.) persons over 65.

EXCUSE FROM JURY DUTY

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