Care Provider Exemption Record {JUR004} | Pdf Fpdf Docx | California

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Care Provider Exemption Record {JUR004} | Pdf Fpdf Docx | California

Last updated: 9/11/2023

Care Provider Exemption Record {JUR004}

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JUR004 - FULL TIME CHILDCARE / CARE PROVIDER REQUEST FOR EXCUSAL FROM JURY DUTY. This form is used by individuals who have a verifiable, non-professional obligation to provide personal care for a child under 12 years of age or for a sick, aged, or infirm family member during the hours of 8:00 a.m. and 5:00 p.m., Monday through Friday. If these individuals have no feasible alternative arrangements for care and have been summoned for jury duty, they can complete and submit this form to request an excusal from jury duty. The form also contains a declaration section where the juror must affirm, under penalty of perjury, that the information provided is true and correct. There is space for the date and telephone number, and the juror is required to sign the form. Once completed, the form is typically returned to the Marin County Superior Court's Office of Jury Services by mail, fax, or email at least five (5) business days before the juror's scheduled appearance date. The court will then review the request and provide a decision by mail.

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