MADISON COUNTY CIRCUIT COURT - JURY DUTY REQUEST TO BE EXCUSED STATE OF MISSISSIPPI COUNTY OF MADISON I, Full Name * , first being duly sworn, state that I have been summoned to jury duty before the Circuit Court of Madison County, Mississippi and am unable to serve the week of Date * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20252026 and that I do not wish to serve for the following reasons: Reasons * Over 65 - Personal Exemption Privilege MS Code 13-5-25 I no longer live in Madison County. Other: I no longer live in Madison County Please provide a new address, phone number and sign to be removed from the voter roll: Address Phone Number Other Reason Juror Signature Clear signature Phone # * Email * Your excuse and/or supplemental documentation may be returned to the court in any of the following ways: U.S.Mail Madison County Circuit Court Jury Department P.O.BOX 1626 Canton, MS 39046 (601) 859-4365 Email: jury@madison-co.com ALL EXCUSES MUST BE RECEIVED ON FRIDAY PRIOR TO JURY DUTY Leave this field blank
