Surveys, Forms and Service Requests

Print
Press Enter to show all options, press Tab go to next option

Jury Summons Response Form

Please correct the field(s) marked in red below:

Thank you for responding to the Summons for Jury Duty you recently received from the City of Charlottesville Circuit Court.

Please provide the following information so that we can respond to you accordingly.

1
Name
 *
2
Current Address
 *
Current Address
3
Email Address
 *
4
Reason for Response
 *
  1. To receive a copy of your submission, please fill out your email address below and submit.
    CAPTCHA
    Change the CAPTCHA codeSpeak the CAPTCHA code