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2. Instructions
   You may claim a statutory exemption by completing the following online jury affidavit and clicking submit. By submitting the form below, you are certifying that the information submitted is true and correct.
   
   For additional options on how to claim an exemption or additional questions pertaining to this summons, contact the court at 817-952-2151.
4. I do solemnly swear that I am exempt from jury service for the reason indicated below:

   1. Persons over 75 years of age.
   2. Persons who have legal custody of a child or children under the age of 12 years if jury service by that person would necessitate leaving the child or children without adequate supervision.
   3. All students of public or private secondary school.
   4. Every person who is enrolled and in actual attendance at an institution of higher education.
   5. Persons who are the primary caretaker of a person who is an invalid unable to care for himself or herself.
   6. An officer or an employee of the Senate, House of Representatives or any department, commission, board, office, or other agency in the legislative branch of state government.
   7. He/she has served as a petit juror in the county during the 24-month period preceding the date he/she is to appear for jury service. (Only applies to counties with population at least 200,000 unless.)
   8. No longer reside in Bedford, Texas. (Update address below. You must submit a copy of your valid government issued ID such as a drivers license).
   9. Not a citizen of the United States.
6. New Address

   If you have moved out of Bedford, please include your new address and a submit a copy of your valid government issued ID, such as a drivers license. 

7. Valid Government Issued ID
9. Electronic Signature Agreement*

   By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

   1. I agree. Electronic Signature
11. Signature Agreement Name*
    Please enter your full name.
Leave This Blank:


13. 1. Receive an email copy of this form.
14. Email address

    This field is not part of the form submission.

15. Submit

* indicates a required field