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2. Franklin County Superior Court
   Juror Attestation of Eligibility
   To Serve as a Juror Under RCW 2.36.100 (2)

4. 1. I hereby attest that I am eighty (80) years of age or older and am unable to serve due to health reasons.

6. I hereby state under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct.

8. Signature of Juror*
10. Date*
    Date
11. City*
12. State*

14. Please provide name, address, telephone number and juror number below.

16. Name*
18. Address*
20. City*
21. State*
22. Zip Code*
24. Phone Number*
25. Jury Number*
Leave This Blank:


27. 1. Receive an email copy of this form.
28. Email address

    This field is not part of the form submission.

29. Submit

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