JURY QUESTIONNAIRE
JURY QUESTIONNAIRE FOR JURY TERM: YOU HAVE BEEN SUMMONED to serve as a juror on a Criminal/Civil Jury that is scheduled to begin on __________________ at _________ am. Please COMPLETE the following and return to: Judges’ Office; 100 East Bayou Street, Suite 202; Farmerville, La. 71241. If possible, please FAX TO (318) 368-2487. ANY QUESTIONS, CALL (318) 368-9734. PLEASE COMPLETE THE FOLLOWING AND RETURN TO OUR OFFICE Name: ______________________________________________________ Date: ____________________ Address: City _______________________ If you live outside the city limits of Farmerville, how many miles do you live from the Courthouse? ________ TELEPHONE NUMBERS: (Home) ___________ (Work) ____________ (Cell) ___________ Date of Birth __________ Place of Birth _______________ Where did you grow up? ____________________ Married Single Widowed Divorced Separated MAIDEN NAME: __________________ Children? (yes) _________ (No) ________ If yes, Number of girls? __________ Number of boys? ___________ Do you have grandchildren? _______ How Many? _______ Religious Preference? _____________________ Do you still live in Union Parish? _________ How long have you lived in Union Parish? _______________ Are you employed? ______ For whom? __________________________ How long?__________________ What is your job? ____________________ Do you supervise others? _____ If so, how many? _________ Is your spouse employed? ________ If so, by who? ______________________ How long? ___________________ Are you a high school graduate? _____ Name of School _______________________________________________ College Graduate? __________ Name of College _____________________________________________________ You or your spouse served in the military? _____ If so, what branch? ________When did you serve? _________ Ever served on a jury? ________ If yes, what type? (Civil) _______ (Criminal) _______ (Grand Jury) _______ Have you or an immediate member of your family ever been convicted of a felony? ___________________ If yes, who? ____________________________ For what crime? __________________________________ ********************************************** ******************************************** EXEMPTION FROM JURY DUTY I REQUEST TO BE EXCUSED FROM JURY DUTY Louisiana law states certain qualifications for Jurors and certain exemptions from Jury service. Qualifications: (1) Citizen of U.S. & Louisiana, residing in Union Parish for one year prior to jury service (2) Be at least 18 years of age; (3) Read, write and speak the English language; (4) Not be under interdiction or incapable of serving due to mental or physical infirmity; (5) Not be under indictment for a felony nor have been convicted of a felony for which he has not been pardoned. Exemptions: (1) All persons over seventy years of age, (2) Persons who have served as grand or petit jurors during a period of two years immediately preceding their selection for jury service. I DESIRE TO BE EXCUSED FROM JURY DUTY BECAUSE: (Can only be excused from jury duty by the Judge. Call the week before the jury term during business hours to find out if you have been excused.) _________ I am more than 70 years old and do not wish to serve. My birth date is _______________________ _________ My doctor is providing information concerning my health. _________ I cannot read, write or speak the English language. _________ OTHER, please specify (write on back f needed) ______________________________________ SIGNATURE___________________________________________________________________________ TELEPHONE #____________________________________________.To be reached during the day TO DETERMINE IF YOUR SERVICES ARE STILL REQUIRED, PLEASE CALL (318) 368-9734 AFTER 5:00 PM . * Very often the trial will not take place because ii has been settled out of court. We will leave a recorded message so that you may know f the matter has been settled and whether or not you will be needed. If you fail to call ,and you report to duty, even though the trial has been cancelled, we will not be able to reimburse you for your expense. ................
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