First Name (Required)

Middle Name (Required)

Last Name (Required)

Juror Number (Required)

City (Required)

State (Required)

Zip Code (Required)

Occupation

Employer

How long have you been at this employer?

If less than 5 years or if retired:

Prior Occupation:

Prior Employer:

Marital Status: SingleDivorcedMarriedWidow(er)

Spouses Name:

Spouses Occupation:

Spouses Employer:

Names, Ages and Occupations of Children:

1. Have you ever been a Petit Juror or Grand Juror before?
YesNo

If yes, when & in which county:

2. Have you ever been involved in a lawsuit, including a divorce, as either a plaintiff or defendant?

YesNo

If yes, type of case:

3. Has any member of your family been involved in a lawsuit as either a plaintiff or defendant? (Family is defined as spouse, parent, sibling, or child)

YesNo

If yes, please specify who and type of case

4. Have you or any family member ever been called as a witness in a lawsuit?

YesNo

If yes, type of case:

5. Are you party to a lawsuit pending for trial in Livingston County?

YesNo

If yes, please list case number:

6. Have you or any immediate member of your family been charged with any offense other than a traffic ticket?
YesNo

If yes, who was charged, type of offense & in which country:

7. Have you or any family member been a victim of a crime?

YesNo

If yes, please specify who and type of crime:

8. Do you have any relative, close friend, or neighbor who is a police officer, employed at a correctional facility, or engaged in law enforcement work?
YesNo

If yes, please state who & what agency:

Signature:
Today's Date (mm/dd/yyyy):

Complete this Captcha: