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The response form completed only to request a postponement or an excuse or to report that the juror is not qualified (a qualified juror not requesting either bringing the entire form on the Date to Appear); the form and any attachments submitted to the court at least 5 business days prior to the Date to Appear by email (jury@mono.courts.ca.gov), fax (760-923-8588), mail to the Jury Commissioner, PO Box 1037, Mammoth Lakes CA 93546, or the drop box at the Mammoth Lakes courthouse; the grounds of disqualification and excuse with the verification to attach (a permanent disability described with a copy of the driver license at age 70 or over, or with a physician's signed statement giving the medical license number under age 70); a postponement for a temporary disability, the care of a family member or another stated reason, the juror giving a date of availability within 90 calendar days
California > Third Appellate District > Mono County > Superior Court of California, County of Mono
Jury Summons RESPONSE FORM Please complete the RESPONSE FORM below only if you are requesting a postponement, an excuse, or are not qualified. If you are qualified and NOT requesting a postponement or excuse, bring this entire form with you on the Date to Appear. Separate along the dotted line and submit this form, along with any attachments, to the Court at least 5 business days prior to the Date to Appear. Please provide your email address for faster response. Submit to Court by: • Email: jury@mono.courts.ca.gov • FAX: 760-923-8588 • Mail: JURY COMMISSIONER PO BOX 1037 MAMMOTH LAKES CA 93546 • Drop Box: Located at Mammoth Lakes courthouse; 100 Thompsons Way, Mammoth Lakes ----------------------------------------------------------------------------------------------------------------------------------------------- RESPONSE FORM NOT QUALIFIED - REQUEST FOR EXCUSE: I am not qualified to serve as a juror because: I am not a citizen of the United States (attach verification). I do not have sufficient knowledge of the English Language. I am less than 18 years of age (attach verification). I am not a resident of Mono County (attach verification). I am currently in prison or jail. I have been convicted of a malfeasance in office and my civil rights have not been restored. I have been convicted of a felony and I am currently on parole, post release community supervision, felony probation or mandated supervision. I am currently required to register as a sex offender pursuant to Section 290 of the Penal Code based on a felony conviction. I am currently serving as a Grand Juror. I am a Peace Officer as defined by PC830.1 or PC 830.2(a). I am the subject of a conservatorship. I have a Permanent Physical or Mental Disability which prevents me from serving. If you are age 70 or over, please describe your disability or impairment including a copy of your driver license. If you are under age 70, you must enclose a signed, written statement describing your disability or impairment signed by physician. The statement must include the physician’s medical license number (attach written verification signed by your physician explaining your condition and delcairing that it is permanent). This person is deceased (attach verification) I CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT. Juror Signature: ___________________________________________ ___________________________ ____________________________ Juror Name Juror Email NAME OR ADDRESS CHANGE – Complete the following information ONLY if different from summons. First: _____________________ Middle: ___________ Last: ________________________________________ Address: ____________________________________ City: _______________________________________ State: __________ Zip Code: ____________________ Email: _______________________________________ REQUEST FOR POSTPONEMENT: I am qualified to serve as a juror, however; I request to be postponed because: I have a temporary physical or mental disability which prevents me from serving at this time. (Attach written verification signed by your physician explaining your condition.) I provide actual and necessary care to a family member. (Attach written verification signed by family member’s physician explaining their relation to you, condition and reason for care. This does NOT include ordinary care for minor children.) OTHER – I am not available as scheduled for the following reason (if more room is needed please attach a separate sheet): __________________________________________ I am available to serve as of: _____/_____/_____ (within 90 calendar days)
Jury Summons RESPONSE FORM Please complete the RESPONSE FORM below only if you are requesting a postponement, an excuse, or are not qualified. If you are qualified and NOT requesting a postponement or excuse, bring this entire form with you on the Date to Appear. Separate along the dotted line and submit this form, along with any attachments, to the Court at least 5 business days prior to the Date
Reviewer note: Composed 2026-10-12 (California T4 Mono build 2026-10-12) from BenchPath custody ca/t4/ca-mono/docs/request-jury-excusal-or-postponement.pdf (160201 bytes, sha256 11a8bc5a10c2b5a1408f3692867f511081866c9fa31331d699549ed005403185; 1 page; a printed text layer) with the shared verbatim composer (v2 reflow): its one page composed, the lower half - set in two columns (the qualifications and the certification at the left, the name or address change and the request for postponement at the right) - read column by column at a gutter of 360 pt; no chrome; 3 whitespace-only fix windows (build/doc-fixes.json: the dotted separator line and the second “RESPONSE FORM” title, joined by the composition, split; the certification's two printed lines, “I CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE” / “AND CORRECT.”, rejoined; two postponement check-box items, joined by the composition, split); proof 1 (whitespace-only) and proof 2 (same character multiset as the text layer minus chrome) pass.
6 verbatim requirements on divisional requirements in GIUSEPPINA MIRANDA's division.
4 verbatim requirements on divisional requirements in HILARY CREARY's division.
2 verbatim requirements on divisional requirements in NATASHA DEPRIMO's division.