Free jury duty excuse letter template 12
Download the document to the computer for easy use
There are more pages to preview,Read on

Jury Duty or Court Service Leave Form

Please complete this form upon return from Jury Duty or Court Service. Attach a copy of the original
notification from the court and the check with check stub for payment received for jury duty/court servi
as well as your personal check for the amount indicated in the box below.

Name _________________________________________________________________________
Department ________________________________ Supervisor __________________________
Date(s) of Jury Duty/Court Service: _________________________________________________
Date Returned to Work: __________________________________________________________

Total Amount Received from Court for Jury Duty/Court Service:

$___________

(Minus) Amount Allowed for Mileage:

$___________

*Amount Due College:

$___________

* Attach personal check (made payable to Mott Community College) for this amount.

____________________________________________________

________________

Employee Signature

Date

_____