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Juror Personal History Questionnaire MC 321b - Michigan
| Juror Personal History Questionnaire Form. This is a Michigan form and can be used in General Statewide . |
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Approved, SCAO STATE OF MICHIGAN JUROR NO. JUDICIAL DISTRICT JUROR PERSONAL HISTORY JUDICIAL CIRCUIT QUESTIONNAIRE COUNTY PROBATE Court address Court telephone no. PLEASE PRINT CLEARLY 1. Last name First name Middle initial 2. Indicate city, township, or village in which you live. City Township Village of: 3. What is your occupation? 4. Employers name and address 5. What other occupations have you had in the last 10 years? 6. Have you ever been an office holder for any state, county or municipality, or have you ever been a law enforcement officer? Yes No If yes, please specify. 7. What was the last grade you completed in school, 8. Marital status Single Married or degree received? Widowed Separated Divorced 9. Name of spouse 10. Spouses occupation 11. Spouses employer 12. Number of children living at home13. Check if you are: Tenant 14. Do you drive? Property owner Landlord Yes No 15. a. Have you, a family member, or a close friend ever been in a serious traffic accident?Yes No b. Was alcohol involved?c. Who was injured? Yes No Yourself Family member(s) Other(s) No one 16. Have you ever been a victim, witness, plaintiff, or defendant in a criminal or civil suit?Yes No If yes, explain: 17. Have you ever been convicted of a misdemeanor other than traffic violations?Yes No If yes, what? 18. Are there any special accommodations the court needs to make to assist you in Yes No serving as a juror? If yes, please explain the accommodations which would be necessary. I declare that the statements above are true to the best of my information, knowledge, and belief. Date Signature MC 321b (6/03) JUROR PERSONAL HISTORY QUESTIONNAIRE MCR 2.510
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