On the _______day of ______ in the year_____, before me, the undersigned notary public, personally appeared. This modification allows us to send an acknowledgment receipt and copy of filed image.In completing this form employees will be acknowledging in writing that their second job is subordinate to their employment with Nassau County. Please call the toll-free automated jury information system at 1-866-851-8154 for up-to-date information on your request 5 days prior to your reporting date.