New York Codes, Rules and Regulations
Title 22 - JUDICIARY
Subtitle D - Forms
Chapter VIII - Forms Required By Section 527 Of Judiciary Law And Section 128.12 Of Nycrr Relating To The Jury System (cf.section 128.12)
Notices of Noncompliance
Form UCS-136 - Failure to respond to summons for jury service

NOTICE OF NONCOMPLIANCE

FAILURE TO RESPOND TO

SUMMONS FOR JURY SERVICE

TO: ____________

____________

____________

PLEASE TAKE NOTICE that, pursuant to section 527 of the Judiciary Law, you are charged with failure to respond to a summons for jury service to begin on ________, 19________.

You are hereby required to respond to the above charge within 20 days of the date of this notice by checking the appropriate box at the bottom of this form, signing your name, and returning this form to:

____________

____________

____________

____________

Your response will be submitted to the Supreme Court, ________ County. If you admit the conduct charged, or if the charges are sustained after a hearing, you will be ordered to perform jury service at a future date certain, and the Court also may impose against you a financial penalty, not to exceed $250. If you request a hearing, you will be advised by the Court of a hearing date at which you will be required to appear in court. You may be represented by an attorney at this hearing.

Failure to respond to this notice shall be deemed an admission of the conduct charged, and a default judgment may be entered against you by the Supreme Court for a penalty in an amount up to $250, together with an order directing that you perform jury service at a future date certain.

Dated: ________

______________

Commissioner of Jurors

............

(DO NOT DETACH)

Response to Charges

[ ] I admit the conduct charged in this notice.

[ ] I request a hearing before a judge or judicial hearing officer.

______________

(Signature)