Free jury duty excuse letter template 15
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Affidavit for Excuse or Deferral from Jury Duty
________________________County, Georgia
Juror Name:
(Print name)


Juror Address:


Juror Telephone Number: ________________________________________________
I hereby affirm that I am the primary care giver
having active care and custody of a
child(ren) six years of age orand
that I have no reasonably available alternative child
care and that I request to be excused or deferred from jury duty in accordance with O.C.G.A.
§15-12-1 (a) (3).
This the _________ day of ___________________, 20_____.

Signature: ________________________

the ____ day of ______________, 20___ .
Notary Public
My Commission Expires: ________________________