State your name, juror number, court date, and address. To be unqualified or ineligible to serve jury duty under Illinois Law.The duration of this serious medical condition is (please select one):. ____ Permanent; jury service in the future will not be possible. The Supreme Court Commission on Access to Justice has approved the following forms. All Illinois Courts must accept these forms. Some valid reasons include: You have a medical condition and jury service presents a hazard to your health. You are an active member of the military. Please excuse (GRADE AND NAME) from jury duty. If you have questions or cannot accommodate this request, please contact me at (COMMANDER'S DUTY PHONE.