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Date of Birth: (Enter date of birth in format month/day/year. Example: 01/15/59 or 12/05/1948)
I HEREBY CERTIFY UNDER PENALTY OF PERJURY UNDER WASHINGTON LAW THAT I AM THE PERSON NAMED ON THE SUMMONS AND THAT THE INFORMATION I PROVIDE IS TRUE AND ACCURATE.

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Failure to appear for jury duty is a misdemeanor pursuant to RCW 2.36.170.1. For more information regarding jury duty, go to http://www.co.pierce.wa.us/index.aspx?NID=1188 or call Superior Court Administration at (253) 798-7606.