Juror Qualification Questionnaire - State Of Louisiana Parish Of Plaquemines printable pdf download

Juror Qualification Questionnaire - State Of Louisiana Parish Of Plaquemines

State of Louisiana Parish of Plaquemines

Juror Qualification Questionnaire

This questionnaire is necessary to determine your qualifications for jury duty in Plaquemines Parish, Louisiana. It

must be filled out and returned, in the self-addressed envelope, within seven (7) days. The enclosed summons

indicates the time and place at the Courthouse to which you should report for jury duty, unless otherwise

excused.

Failure to return this completed form may require a personal appearance before the court.

Name: (MR) (MRS) (MS)_________________________________________________

ADDRESS:____________________________________________________________

CITY_________________________________ STATE_______ ZIP_______________

HOME PHONE:________________________ CELL PHONE:____________________

SOCIAL SECURITY NO.___________________ DATE OF BIRTH:_________________

Please enter above your correct name, address and telephone number.

YES

(Check one)

⁭

Have you served on a jury (not Federal jury) within the past two (2) years?

If yes, where and when?________________________________________

⁭

Are you a citizen of the United States and the State of Louisiana, over the age of eighteen (18)

Years?

⁭

Have you been a resident of Plaquemines Parish for the past twelve (12) months?

If not, for how long?___________________________________________

⁭

Are you able to read, write, speak and understand the English language?

⁭

Are you ineligible to vote because of a felony conviction?

⁭

Do you have any problem, such as illness, undue hardship or extreme inconvenience which would

Affect your ability to serve on jury?_______________________________

If yes, explain_________________________________________________

⁭

Do you clearly understand you are NOT excused unless the Judge notifies you that you have been

Excused?

⁭

Are you age seventy (70) years or older and do you wish to claim your exemption?

Juror No._______________

Sign Here:_______________________________________________

Date of Jury Service:___________________________

Juror Qualification Questionnaire - State Of Louisiana Parish Of Plaquemines