In order to qualify for a disqualification, you must meet one of the following criteria listed below. If you do not meet one of these criteria, you may apply for a postponement only. Reason for Disqualification Reason for Disqualification I am not a Citizen of the United States. I am not Eighteen years of age or older. I am unable to read, speak and understand the English language. I am not a resident of Colorado and will NOT return to reside in Colorado in the next 12 months. You still qualify if you are traveling outside of the county. The summons I have received is not from the county in which I reside. I am currently serving as a juror OR I have served as a juror within the last 12 months OR I have reported for jury service this calendar year OR I am scheduled for jury service within the next 12 months. I have a serious physical or mental illness and would like to be excused. I have the sole responsibility for the daily care of a permanently disabled person living in the same household and do not work outside the home. I am breastfeeding a child and am temporarily unable to leave the child and would like to be excused. Supporting Disqualification Documentation If you selected that you are currently serving as a juror OR I have served as a juror within the last 12 months OR I have reported for jury service this calendar year OR I am scheduled for jury service within the next 12 months: You must attach verification of previous service or upcoming service with this request.If you selected that you have a serious physical or mental illness and would like to be excused you must attach a statement from a licensed medical provider, mental health provider, or Christian Science practitioner stating you are unable to perform jury service, and the length of the disqualification with this request. Request For Medical Disqualification Or Postponement From Jury Service (C.R.S. § 13-71-105)If you selected that you have the sole responsibility for the daily care of a permanently disabled person living in the same household and do not work outside the home you must attach a statement from a licensed medical provider or Christian Science practitioner stating you are unable to perform jury service with the above information with this request. Request For Caretaker Postponement From Jury ServiceIf you selected that you are breastfeeding a child and am temporarily unable to leave the child and would like to be excused you must attach a statement from a licensed medical provider or Christian Science practitioner stating you are unable to perform jury service because you are a nursing mother with this request.One file only.100 MB limit.Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods. Summons Information County (as it appears on your summons - required)? - Select -Adams CountyAlamosa CountyArapahoe CountyArchuleta CountyBaca CountyBent CountyBoulder CountyBroomfield CountyChaffee CountyCheyenne CountyClear Creek CountyConejos CountyCostilla CountyCrowley CountyCuster CountyDelta CountyDenver - DistrictDenver - JuvenileDenver - ProbateDolores CountyDouglas CountyEagle CountyEl Paso CountyElbert CountyFremont CountyGarfield CountyGilpin CountyGrand CountyGunnison CountyHinsdale CountyHuerfano CountyJackson CountyJefferson CountyKiowa CountyKit Carson CountyLa Plata CountyLake CountyLarimer CountyLas Animas CountyLincoln CountyLogan CountyMesa CountyMineral CountyMoffat CountyMontezuma CountyMontrose CountyMorgan CountyOtero CountyOuray CountyPark CountyPhillips CountyPitkin CountyProwers CountyPueblo CountyRio Blanco CountyRio Grande CountyRoutt CountySaguache CountySan Juan CountySan Miguel CountySedgwick CountySummit CountyTeller CountyWashington CountyWeld CountyYuma County Location (as it appears on your summons - required)? - Select -Adams County Justice CenterAlamosa Combined CourtArapahoe County Courthouse - LittletonArapahoe County Justice CenterArchuleta County CourthouseBaca County CourtBent Combined CourtBoulder County Combined CourtBoulder County Combined Court - LongmontBroomfield Combined CourtsChaffee Combined Court Cheyenne County CourthouseClear Creek County CourthouseConejos Combined CourtCostilla Combined CourtCrowley Combined CourtCuster Combined Court Delta County Combined CourtDenver City & County Bldg (Civil and Domestic Matters)Denver Juvenile CourtDenver Probate CourtDolores Combined CourtDouglas County CourthouseEagle County - El JebelEagle County Justice CenterEl Paso County Judicial BuildingElbert County CourthouseFremont Combined Court Garfield County Associate Court - RifleGarfield County CourthouseGilpin Combined CourtGrand County Judicial CenterGunnison County Combined CourtHinsdale County CourthouseHuerfano County Judicial CenterJackson County Combined CourtJefferson Combined CourtKiowa County Combined CourtKit Carson County Combined CourtLa Plata County CourthouseLake County Justice CenterLarimer County Justice Center Las Animas County CourthouseLincoln County CourthouseLindsey-Flanigan Courthouse (Criminal Matters)Logan County Combined CourtsLoveland County Court Mesa County Justice CenterMineral Combined CourtMoffat Combined CourtMontezuma Combined CourtsMontrose County Justice CenterMorgan Combined CourtNucla Montrose Associate CourtOtero Combined CourtOuray County CourthousePark Combined CourtPhillips Combined CourtPitkin County CourthousePlaza WestProwers County Combined CourtPueblo Combined CourtRalph L. Carr Judicial CenterRio Blanco Combined CourtRio Blanco County Associate Court Rio Grande Combined CourtRoutt County Combined CourtSaguache Combined CourtSan Juan County CourthouseSan Miguel County CourthouseSedgwick Combined CourtState Court Administrator's OfficeSummit County Justice CenterTeller County CourthouseWashington Combined CourtWeld County Centennial CenterWeld County CourthouseYuma County Courthouse Appearance Date (required) Juror Number on Summons (required) Juror Contact Information Your First Name as it appears on the jury summons Your Last Name as it appears on the jury summons My name has changed Enter Your New Name Your Email Address (required) Your Phone (required) I live outside the United States. This is a new address. Mailing Address Current Address (required) P.O. Box / Apt # City (required) State (required) - None -AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingDistrict of ColumbiaAmerican SamoaGuamNorthern Mariana IslandsPuerto RicoUnited States Minor Outlying IslandsVirgin Islands, U.S.Outside the US Zip code (required) County (required) - None -Out of State CountyAdamsAlamosaArapahoeArchuletaBacaBentBoulderBroomfieldChaffeeCheyenneClear CreekConejosCostillaCrowleyCusterDeltaDenverDoloresDouglasEagleEl PasoElbertFremontGarfieldGilpinGrandGunnisonHinsdaleHuerfanoJacksonJeffersonKiowaKit CarsonLa PlataLakeLarimerLas AnimasLincolnLoganMesaMineralMoffatMontezumaMontroseMorganOteroOurayParkPhillipsPitkinProwersPuebloRio BlancoRio GrandeRouttSaguacheSan JuanSan MiguelSedgwickSummitTellerWashingtonWeldYuma My Residential Address is the same as my Mailing Address. Residential Address Current Address (required) P.O. Box / Apt # City (required) State (required) - None -AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingDistrict of ColumbiaAmerican SamoaGuamNorthern Mariana IslandsPuerto RicoUnited States Minor Outlying IslandsVirgin Islands, U.S.Outside the US Zip Code (required) County (required) - None -Out of State CountyAdamsAlamosaArapahoeArchuletaBacaBentBoulderBroomfieldChaffeeCheyenneClear CreekConejosCostillaCrowleyCusterDeltaDenverDoloresDouglasEagleEl PasoElbertFremontGarfieldGilpinGrandGunnisonHinsdaleHuerfanoJacksonJeffersonKiowaKit CarsonLa PlataLakeLarimerLas AnimasLincolnLoganMesaMineralMoffatMontezumaMontroseMorganOteroOurayParkPhillipsPitkinProwersPuebloRio BlancoRio GrandeRouttSaguacheSan JuanSan MiguelSedgwickSummitTellerWashingtonWeldYuma Comments By checking this box, I hereby certify under penalty of perjury that the above information is true and correct. 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Colorado Judicial Branch