J-2, r. 2 - Order number 1890 of the Minister of Justice and Attorney General concerning the Application for exemption or disqualification from jury duty or for postponement of jury duty to a later session

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Jury list number: __________ Given name(s) and surname of prospective juror:
Prospective juror number: __________ ________________________________________
APPLICATION FOR EXEMPTION OR DISQUALIFICATION FROM JURY DUTY OR FOR POSTPONEMENT OF JURY DUTY TO A LATER SESSION
I, the undersigned, having been duly sworn, apply for
□ disqualification from jury duty;
□ exemption from jury duty during the current session; or
□ postponement of jury duty to a later session
on the following grounds (specify the reasons for the disqualification, exemption or postponement)
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
_________________________________________ ________________________________________
Date SIGNATURE OF THE PROSPECTIVE JUROR


□ Sworn _____________________________________
| IMPORTANT NOTICE |
| |
| THIS APPLICATION MUST BE MADE BY |
| CERTIFIED OR REGISTERED MAIL |
At____(city or town), on ____(date of oath) | WITHIN 20 DAYS OF RECEIVING THIS |
| SUMMONS. PLEASE ATTACH ANY |
_________________________________________ | NECESSARY SUPPORTING DOCUMENTS |
Name and qualification of person | SUCH AS A DETAILED MEDICAL |
authorized to administer oaths | CERTIFICATE OR A BIRTH CERTIFICATE. |
|_____________________________________|
M.O. 1890.