New Mexico Affidavit of Age/Request for Permanent Exemption from Jury Service Form - Free Download
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New Mexico Affidavit of Age/Request for Permanent Exemption from Jury Service Form
New Mexico Affidavit of Age/Request for Permanent Exemption from Jury Service Form
_______________________ COURT
COUNTY OF __________
STATE OF NEW MEXICO
AFFIDAVIT OF AGE/
REQUEST FOR PERMANENT EXEMPTION FROM JURY SERVICE
STATE OF NEW MEXICO )
) ss.
COUNTY OF ________________ )
I state, under penalty of perjury, that to the best of my knowledge and belief, the following
statements and information are true and correct.
I am 75 years of age or older. My date of birth is ___________________, _____________.
I hereby request permanent exemption from jury service in New Mexico due to age pursuant to
Section 38-52 (B) NMSA .
Name (printed): __________________________
Mailing Address: __________________________
__________________________
__________________________
________________________________ ____________________
Signature Date
SUBSCRIBED AND SWORN TO before me by ______________________________________
this _________________ day of _________________________________, 20_____________.
__________________________________
Notary Public
My commission expires: __________________________
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