City of Eugene
Municipal Court Juror Affidavit

Upon submittal you will receive a confirmation message.
Personal Information  
* Required
Todays Date 5/28/2015
Juror Number* (as it appears on jury summons)
Jury Service Date*  (MM/DD/YYYY)  
Last Name*
First Name*
If your name has changed from the name on the summons please call the jury clerk (541-682-5013)
Daytime phone* (###-###-####)  
Please select the section header below that applies to you: 


If you need any accommodations including interpreters, assisted listening devices, wheelchair accessibility, or other considerations please advise below.


I understand that I may ask for one (1) reschedule of my service within the next 90 days. Please re-schedule me to the following date:


Pick one of the following:

Requests to be excused for employment or medical reasons need to have a written, signed letter from your employer or doctor. Print this form and include it with the letter, and submit to the court by fax [541-682-5417] or regular mail to:
Eugene Municipal Court
1102 Lincoln St
Eugene, OR 97401

 Type "I Agree" to certify that the information and statements provided on this Juror Affidavit are true.

Upon submittal you will receive a confirmation message.

If you have additional questions regarding your jury service please call the jury clerk (541-682-5013)