New Mexico Affidavit Of Age/request For Permanent Exemption From Jury Service Form

Transcript

_______________________ COURT COUNTY OF __________ STATE OF NEW MEXICO AFFIDAVIT OF AGE/ REQUEST FOR PERMANENT EXEMPTION FROM JURY SERVICE STATE OF NEW MEXICO ) ) COUNTY OF ________________ ) ss. 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: __________________________