Form JD-JA-49 "Request for Disqualification From Jury Service Based on Previous Federal Jury Service" - Connecticut

What Is Form JD-JA-49?

This is a legal form that was released by the Connecticut Judicial Branch - a government authority operating within Connecticut. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on September 1, 2017;
  • The latest edition provided by the Connecticut Judicial Branch;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form JD-JA-49 by clicking the link below or browse more documents and templates provided by the Connecticut Judicial Branch.

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Download Form JD-JA-49 "Request for Disqualification From Jury Service Based on Previous Federal Jury Service" - Connecticut

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REQUEST FOR DISQUALIFICATION FROM
STATE OF CONNECTICUT
JURY SERVICE BASED ON PREVIOUS
JURY ADMINISTRATION
FEDERAL JURY SERVICE
www.jud.ct.gov
JD-JA-49 New 9-17
P.A. 17-99 § 10
You received a state summons to jury service and claimed that you wish to be disqualified
ADA NOTICE
based on previous federal jury service. Before your claim may be considered, this form
The
Judicial
Branch
of
the
State
of
must be completed and returned to Jury Administration.
Connecticut complies with the Americans with
Disabilities
Act
(ADA).
If
you
need
a
Please fax, or scan and e-mail this form to Jury Administration.
reasonable accommodation in accordance
The fax number is (860) 263-2770. The e-mail address is Jury.Administration@jud.ct.gov.
with the ADA, contact a court clerk or an ADA
You may also mail this form directly to Jury Administration, P.O. Box 260448, Hartford, CT
contact person listed at www.jud.ct.gov/ADA.
06126-0448.
Juror Identification Number (letters and numbers)
Name of Juror (as shown on your Connecticut jury summons)
Telephone number
Street Address of Juror
City/Town
State
ZIP Code
I. VERIFICATION OF YOUR CLAIM OF FEDERAL JURY SERVICE
To be disqualified based upon previous federal jury service, you must have served in the United States District Court for
the District of Connecticut as:
(A) a federal juror on a matter that has been tried to a jury during the last three preceding jury years,* or
(B) a federal grand juror during the last three preceding jury years.*
Please note that merely appearing for federal jury service is not sufficient for disqualification. To be eligible for
this disqualification, you must have appeared for federal jury service and served on a jury as previously
described.
Court Location of Federal Jury Service
Date of Federal Jury Service
During the last three preceding jury years,*
I served as a juror on a matter tried to a jury
or
I served as a federal grand juror
*A jury year begins on September 1, and ends on August 31 of the following year.
II. CLAIM
I claim that the information above is accurate to the best of my knowledge and belief.
Print name
Date signed
Signed (Juror)
u
Print Form
Reset Form
REQUEST FOR DISQUALIFICATION FROM
STATE OF CONNECTICUT
JURY SERVICE BASED ON PREVIOUS
JURY ADMINISTRATION
FEDERAL JURY SERVICE
www.jud.ct.gov
JD-JA-49 New 9-17
P.A. 17-99 § 10
You received a state summons to jury service and claimed that you wish to be disqualified
ADA NOTICE
based on previous federal jury service. Before your claim may be considered, this form
The
Judicial
Branch
of
the
State
of
must be completed and returned to Jury Administration.
Connecticut complies with the Americans with
Disabilities
Act
(ADA).
If
you
need
a
Please fax, or scan and e-mail this form to Jury Administration.
reasonable accommodation in accordance
The fax number is (860) 263-2770. The e-mail address is Jury.Administration@jud.ct.gov.
with the ADA, contact a court clerk or an ADA
You may also mail this form directly to Jury Administration, P.O. Box 260448, Hartford, CT
contact person listed at www.jud.ct.gov/ADA.
06126-0448.
Juror Identification Number (letters and numbers)
Name of Juror (as shown on your Connecticut jury summons)
Telephone number
Street Address of Juror
City/Town
State
ZIP Code
I. VERIFICATION OF YOUR CLAIM OF FEDERAL JURY SERVICE
To be disqualified based upon previous federal jury service, you must have served in the United States District Court for
the District of Connecticut as:
(A) a federal juror on a matter that has been tried to a jury during the last three preceding jury years,* or
(B) a federal grand juror during the last three preceding jury years.*
Please note that merely appearing for federal jury service is not sufficient for disqualification. To be eligible for
this disqualification, you must have appeared for federal jury service and served on a jury as previously
described.
Court Location of Federal Jury Service
Date of Federal Jury Service
During the last three preceding jury years,*
I served as a juror on a matter tried to a jury
or
I served as a federal grand juror
*A jury year begins on September 1, and ends on August 31 of the following year.
II. CLAIM
I claim that the information above is accurate to the best of my knowledge and belief.
Print name
Date signed
Signed (Juror)
u
Print Form
Reset Form