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                                                                                 Official Jury Summons-Juror Questionnaire
                                                                                     District Court
                                                                                          Jury Summons No.

Name:
Address:
City or Town:
State or Province:
Zip or Postal Code:

   
                                                                                                                                                                         

 MaleFemale Race Age Birth Date
 Are you a US citizen?   yes no
Name:
Address:
City or Town:
State or Province:
Zip or Postal Code:
Phone:
 Occupation:
 Employer:  
 Work Phone:   How Long:
 Spouse's name  
 Spouse's occupation:    How long: 
 Spouse's employer:
 Have you served on a      Civil jury?   yes   no          Criminal jury?  yes   no   
 Current Marital status: Single   Married  Widowed   Divorced
 Number of children:     Ranges of age:
 Highest level of education Did not receive H.S. Diploma
High School Diploma
GED
2 years of college
4 years of college/university
Post Graduate           Other
   

                  I certify that all answers are true and correct: 
                                                                                     Juror summons number: 

                                                                                                                                        

 

 
 Jury Information

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