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Jury Questionnaire


  1. 1. Page 1
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  3. 3. Page 3
  • Page 1

    1. Number is located under barcode.
    3. Please Complete:
    4. Type "Same" if physical address is the same as the mailing address. Otherwise, enter full physical address above including City, State and Zip Code.
    5. It is very important that you list where you can be contacted during the day.
    6. Marital Status:*
    7. Employment:*
    8. Please indicate gender:
    9. Are you of Hispanic or Latino Ethnicity?
    10. Please indicate race:*
    11. These answers are required solely to avoid discrimination in juror selection and have absolutely no bearing on qualifications for jury service. By answering these questions, you help the court monitor the juror selection process so that discrimination does not occur. In this way the court can fulfill its legal obligation to provide jurors who are randomly selected from a fair cross section of this community.