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Jury Questionnaire


In an effort to select fair and inpartial juries, your cooperation is needed in answering the following questions. The information that you provide will be used by the judge and lawyers during the impaneling of a jury. This questionnaire is provided to attorneys and pro se parties. The information in this questionnaire shall not be otherwised disclosed, nor may it be reproduced.


Privacy Act Statement: Your social security number is requested on a voluntary basis under authority of section 6041 and 6109 of the Internal Revenue code. If you earn more than $600 in compensation as a juror, the court must inform the Internal Revenue Service using your social security number, and it is helpful to get your number now. Failure to provide your social security number at this time will not disqualify you from serving as a juror, but it may delay jury service payments to which you become entitled.