Huron County Common Pleas: Jury Questionnaire

Questionnaire Date

Dec 21, 2024

I NO LONGER LIVE IN HURON COUNTY

Last Name *

First Name *

Middle Initial

New Address *

Apt

New City *

State *

New Zip Code *

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Questionnaire for Jury Duty

Last Name *

First Name *

Middle Initial

Age *

Maritial Status *

State Your City *

Your Occupation *

Highest Level of Education *

Name your current employer, or if retired your former employer *

Spouse's Occupation (type NA if Not Applicable) *

Ages of Children (type NA if Not Applicable) *

Grown Children's Occupation (type NA if Not Applicable) *

Have you had prior jury service? *

Have you ever been convicted of a felony? *

Have you or any member of your family filed a lawsuit or been sued? *

Have you or any member of your family made a claim for damages that did not result in a lawsuit? *

Have you or any member of your family been the victim of a crime? *

Are you related to or a close friend of a law enforcement officer or prosecutor? *

If you answered "Yes" above, please give a brief explanation

Request to be excused/postponed from jury service
Even if you are requesting to be excused or postponed you still need to complete the top section "Questionnaire for Jury Service"

Interests of the public will be materially injured by your having to perform jury service. Please explain:

Your spouse or a near relative has recently died or is dangerously ill.
Send physician's statement to the Court of Common Pleas

You are a cloistered member of a religious organization.

Jury service requires you to abandon a person under your personal care of supervision.
Send physician's statement to the Court of Common Pleas

You are over 75 years of age and request to be excused.

You suffer from a mental/physical condition making you unable to perform jury service.
Send physician's statement to the Court of Common Pleas

You have had jury service within twelve months prior to receiving this jury service notification.

You will be out of the county on one or more weeks for which you are scheduled for jury duty. Please state which weeks, where you will be and the reason:

If you wish to have your jury duty postponed to a different term of court, please state the reason(s) for the postponement:

Additional Comments:

Your Name *

Under penalty of Purjury the information provided above is true (if the person signing is not the prospective juror, please indicate your relationship to the prospective juror next to your signature).

BY TYPING MY NAME ABOVE AND SUBMITTING THIS FORM I ACKNOWLEDGE THAT I HAVE READ, UNDERSTOOD AND AGREE TO THE ABOVE STATEMENTS.