2. 
   If you are reporting for service on the date for which you have been summoned, you are in the right place. Please fill out and submit this form. Thank you!
4. 
   If you would like to request a reset or exemption of service, please exit this form and
   go back to the Jury Service page to fill out the Juror Reset, Exemption, or Disqualification form.
6. Juror Confirmation of Service
8. Full Name (first and last name required)*
10. Mailing Address (number, street, apt./suite) *
12. City, State, ZIP Code*
14. Email Address*
16. Primary Phone*
18. Secondary Phone (business, cell, home)
20. 
    Eligibility Status
22. I am a United States citizen*

    1. Yes
    2. No
24. I am at least 18 years of age.*

    1. Yes
    2. No
26. I am eligible to vote.
    (You do not have to be registered, but are eligible to do so).*

    1. Yes
    2. No
28. I am a resident of the City of Southlake.*

    1. Yes
    2. No
30. I have not served as a juror in Tarrant or Denton counties during
    the last three months for a total of 6 or more days.*

    1. Yes, true.
    2. No, not true.
32. I can read and write in English.*

    1. Yes
    2. No
34. If you answered "yes" or "true" to every one of the answers above, you qualify for juror service with Southlake Municipal Court. Please complete and submit this form. We'll see you on the scheduled trial day. Thank you!

    If you answered "no" or "not true" to any question above, you are excused from service.
    Please submit this form to receive a confirmation of excusal from service. Thank you!
36. Final Details for Service
    
38. Recent Jury Service
    Please list (below) any time you have served as a juror in the last 6 months (in municipal, county, state or federal court).
40. Please tell us:
    1. How we can accommodate any ADA* medical conditions when you come for service. (*Americans with Disabilities Act)
    2. If there are any other questions or comments we can address.
42. 
    Please be sure to click the "Submit" button below.
    Thank you!
Leave This Blank:


43. Submit

* indicates a required field