Florida > Statewide > Civil
Questionnaire For Prospective Jurors 1.983 - Florida
| Questionnaire For Prospective Jurors Form. This is a Florida form and can be used in Civil Statewide . |
|
||||||
 Get this form for FREE as a print-only pdf |
|||||||
|
QUESTIONNAIRE FOR PROSPECTIVE JURORS ______________________________________________________________________________________ ______________________________________________________________________________________ (name of authority selecting jury) 1. Name (print)....................................................... (first) (middle) (last) 2. Residence address.............................................. (street and number) (city) (zip) 3. Date of birth....................................................... Sex ........................ Occupation ........................ 4. Do you understand the English language? ............... (yes) ............... (no) 5. Do you read and write the English language? ............... (yes) ............... (no) 6. Have you ever been convicted of a crime and not restored to your civil rights? ............... (yes) ............... (no) If "yes," state nature of crime, date of conviction, and name of court in which convicted: ............................................................................ ............................................................................ 7. Are there any criminal charges pending against you of which you are aware? ............... (yes) ............... (no) If "yes," state nature of charge and name of court in which the case is pending: ........................................................................... ........................................................................... 8. Are you a bonded deputy sheriff? ............... (yes) ............... (no) Questionnaire for Prospective Jurors (1.983) American LegalNet, Inc. www.FormsWorkflow.com 9. List any official executive office you now hold with the federal, state, or county government: ............................................................................ 10. Is your hearing good? ............... (yes) Is your eyesight good? ............... (yes) ............... (no) ............... (no) (The court may require a medical certificate.) 11. Do you have any other physical or mental disability that would interfere with your service as a juror? ............... (yes) ............... (no) If "yes," state nature: ......................................... (The court may require a medical certificate.) 12. Do you know of any reason why you cannot serve as a juror? ............... (yes) ............... (no) If "yes," state reason: ............................................................................ ............................................................................ 13. MOTHERS AND EXPECTANT MOTHERS ONLY: Florida law provides that expectant mothers and mothers with children under 18 years of age residing with them shall be exempt from jury duty upon their request. Do you want to be exempt under this provision? ............... (yes) ............... (no) If "yes," what are the ages of your children? ............................................................................ Signature This is not a summons for jury duty. If your name is later drawn for jury service, you will be summoned by the sheriff by registered mail or in person. Questionnaire for Prospective Jurors (1.983) American LegalNet, Inc. www.FormsWorkflow.com
|
|||||||
