Form AOC-A-183 "Waiver of Juror Fees" - North Carolina

What Is Form AOC-A-183?

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

Form Details:

  • Released on April 1, 2011;
  • The latest edition provided by the North Carolina Court System;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a fillable version of Form AOC-A-183 by clicking the link below or browse more documents and templates provided by the North Carolina Court System.

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Download Form AOC-A-183 "Waiver of Juror Fees" - North Carolina

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STATE OF NORTH CAROLINA
WAIVER OF JUROR FEES
Judicial Branch Of Government
NOTE TO JUROR:
The courts may be required to report juror per diem fees over a certain amount to the Internal Revenue Service
as income. The clerk of superior court and the judge cannot advise you of the possible tax implications of any
juror fees waived or received. If you have any questions about the tax issues related to payment as a juror,
consult a financial professional.
WAIVER
I, the undersigned, hereby waive payment of per diem juror fees as set forth in G.S. 7A-312, for my service on the court
date(s) identified below.
Name And Address Of Juror (Type Or Print)
Date
Signature Of Juror
CERTIFICATION
I certify that the juror named above was on jury duty on the date(s) indicated below and pursuant to the waiver above has
not been paid juror fees for his/her service.
Date(s) Of Jury Duty
Date
Signature
County
Deputy CSC
Assistant CSC
Clerk Of Superior Court
NOTE TO CLERK:
This form is for bookkeeping purposes only. Do not place this form in an individual case file.
AOC-A-183, Rev. 4/11
© 2011 Administrative Office of the Courts
STATE OF NORTH CAROLINA
WAIVER OF JUROR FEES
Judicial Branch Of Government
NOTE TO JUROR:
The courts may be required to report juror per diem fees over a certain amount to the Internal Revenue Service
as income. The clerk of superior court and the judge cannot advise you of the possible tax implications of any
juror fees waived or received. If you have any questions about the tax issues related to payment as a juror,
consult a financial professional.
WAIVER
I, the undersigned, hereby waive payment of per diem juror fees as set forth in G.S. 7A-312, for my service on the court
date(s) identified below.
Name And Address Of Juror (Type Or Print)
Date
Signature Of Juror
CERTIFICATION
I certify that the juror named above was on jury duty on the date(s) indicated below and pursuant to the waiver above has
not been paid juror fees for his/her service.
Date(s) Of Jury Duty
Date
Signature
County
Deputy CSC
Assistant CSC
Clerk Of Superior Court
NOTE TO CLERK:
This form is for bookkeeping purposes only. Do not place this form in an individual case file.
AOC-A-183, Rev. 4/11
© 2011 Administrative Office of the Courts