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City of Missoula
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Affidavit for Excusal from Jury Service

  1. State of Montana
  2. Affidavit for Excusal
  3. City of Missoula Municipal Court
  4. Affiant is informed of having been called as a trial juror in the Municipal Court of Missoula, Montana. Affiant is applying for the following excusal and requests the Court’s review:
  5. PERMANENT EXCLUSION – Must be chronically incapacitated by illness or injury (include Physician’s certification). If Court approves, the Affiant will be permanently excused from jury service.
  6. CHANGE IN RESIDENCE – Affiant no longer resides in County of Missoula, Montana.
  7. UNDUE HARDSHIP – Must state occupation and specific facts which Affiant believes constitutes undue hardship; having in mind jury service constitutes a duty of every competent citizen.
  8. Note: If the Court denies your excuse for undue hardship, you may again submit a request if you are summoned for a trial. Examples of potential undue hardships include military service, move, long-planned vacation, employment out of state, residence out of state, or other unusual personal circumstance. If you know you will be gone for a specific period of time, please list it here:
  9. I declare under penalty of perjury and the laws of the state of Montana that the foregoing is true and correct.
  10. To sign electronically: /s/ (your name)

  11. Leave This Blank:

  12. This field is not part of the form submission.