Request For Disqualification From Jury Service Based On Previous Federal Jury Service {JD-JA-49}

JD-JA-49 - REQUEST FOR DISQUALIFICATION FROM JURY SERVICE BASED ON PREVIOUS FEDERAL JURY SERVICE. This form is used in the Connecticut Jury Administration when a juror who has received a state summons for jury service wishes to be disqualified based on their previous service as a federal juror or federal grand juror in the United States District Court for the District of Connecticut. The completed form must be submitted to the Jury Administration for consideration. The form requires the juror to provide their name, juror identification number, street address, telephone number, city/town, state, and ZIP code. The juror is then asked to verify their claim of federal jury service by indicating the court location and the date of their federal jury service during the last three preceding jury years. The juror must specify whether they served as a juror on a matter tried to a jury or as a federal grand juror. The juror is required to sign the form, print their name, and provide the date of signing to affirm the accuracy of the information provided. Once the completed form is submitted, the Jury Administration will review the request and notify the juror of their decision by mail. C.G.S. § 51-217(a)(10). www.FormsWorkflow.com