NON-RESIDENT AFFIDAVIT TO: LINDA T. MILLER Clerk of Superior Court Jury Division 9151 Tara Boulevard, 1JA09 Jonesboro, Georgia 30236-4912 770-477-3400; fax 770-477-4519 Email: juryclerk@co.clayton.ga.us ****PLEASE NOTE: YOU MAY FAX THIS FORM IN, BUT PLEASE SEND THE ORIGINAL VIA US MAIL SERVICE. THE ORIGINAL FORM MUST BE RECEIVED & RETAINED BY THIS OFFICE. AFFIDAVIT I hereby request that I, , be removed from the jury list because I am no longer a Clayton County resident. I solemnly swear or affirm that I have moved to (county) (street address) ( (city) (state) (zip code) (county) ) (area code) . phone number I also authorize Voter Registration to change their records accordingly. DATE SIGNATURE Juror Name: Juror Number: Service Date: American LegalNet, Inc. www.USCourtForms.com