Fillable Personal Obligation To Provide Care For Minor (NJ Judiciary)

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Personal Obligation To Provide Care For Minor (NJ Judiciary)

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Revised: 01/2020, CN 12140
Superior Court of New Jersey
Certification in Support of Request for Excuse from Jury Service:
Personal Obligation to Provide Care for Minor Child(ren)
Name
County
Candidate ID
Phone or
Email
Summons Date
I, , of full age, hereby certifies as follows:
This certification is made by me in support of my request to be excused from jury service on
, in County.
A person may be excused from jury service for particular reasons, including:
c. Jury service will impose a severe hardship due to circumstances which are not likely
to change within the following year. Severe hardship includes the following
circumstances:
3. The prospective juror has a personal obligation to care for another, including…a
minor child, who requires the prospective juror’s personal care and attention, and no
alternative care is available without severe financial hardship on the prospective juror
or the person requiring care. N.J.S.A. § 2B:20-10(c)(3).
I am personally obligated to care for the following minor child/ren (attach additional sheets as
necessary):
Child’s Name
Child’s Age
1.
2.
3.
4.
I understand that I may be required to provide further information and/or financial documentation for
review by the court in support of this request.
I hereby certify and say that the foregoing statements made by me are true. I am aware that if any of
the foregoing statements made by me are willfully false, I am subject to punishment.
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Personal Obligation To Provide Care For Minor (NJ Judiciary)

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Completed 21 July 2020

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