Request for Excuse/Postponement of Jury Service

This form is solely for the use of federal jurors seeking excuse from jury duty at the United States District Court in the District of New Hampshire.  If you are summoned by the NH state court for your county or any other court, please contact that court for instructions.  The federal court can only process requests for federal jurors. 

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(located near the barcode on summons notice)
                            (house number, street, city, state zip)

** You will be contacted by email or phone with any follow-up questions and the court’s decision.  Please be aware that email is the court’s preferred method to communicate the court’s decision.  The court will not share the email or phone number you provided. **

Please read this form carefully and provide all requested information and any other information you believe necessary for the court to consider your request.

I would like my jury service to be postponed or excused because:

Select at least one excuse.
Select your birth date using either the drop down options or the calendar icon.
For each excuse selected, provide detail(s) here.