Jury Response -

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Oregon Judicial Department

Benton County Circuit Court
Oregon Judicial Department
Juror Response Form

*= Required Fields

Juror Information:

Juror Number:

* (This entry should be 1 to 3 numbers)

Date Scheduled to Appear:

Month: Day: Year: *

Please Fill In Your Name And Address Below As It Appears On Your Jury Summons.

Last Name: *

First Name: *

Middle Name/Initial: *

Address: *

Address (continued):

City: *

State: *

Zip Code: *

Email Address:

This E-mail address will be used to communicate jury information to you, and will not be provided to any entity outside Benton County Circuit Court.

Email Address: *

Confirm Email: *

Attendance:

I WILL ATTEND JURY DUTY ON THE DATE SPECIFIED ON MY SUMMONS

Residency:

I am not a U.S. Citizen. I am a Citizen of

I am not a resident of Benton County.

I am not 18 years of age or older.

I have been convicted of a felony or served a felony sentence within the past 15 years.

Current Address (if different):

Address:

Address (continued):

City:

State:

Zip

Other:

I have served on a Federal or State Jury in the last 2 years.

Where: When:

I wish to be excused because I am over 70 years of age.

Please defer my jury duty to the month of:
Note: You may only defer jury duty for up to one year

1ST Half 2ND Half

Other (This option requires an entry in 'Comments')

Comments:

If you need to communicate with the Jury Coordinator, please call
541-766-6880.

Thank you!