Form 1.984 Juror Voir Dire Questionnaire

JURY QUESTIONNAIRE

Instructions to Jurors

You have been selected as a prospective juror. It will aid the court and help shorten the trial of cases if you will answer the questions on this form and return it in the enclosed self-addressed stamped envelope within the next 2 days. Please complete the form in blue or black ink and write as dark and legibly as you can.

1. Name (print)

(first)                          (middle)                                 (last)

2. Residence address
3. Years of residence: In Florida

                                    In this county

4. Former residence
5. Marital status: (married, single, divorced, widow, or widower)
6. Your occupation and employer
7. If you are not now employed, give your last occupation and employer

8. If married, name and occupation of husband or wife
9. Have you served as a juror before?
10. Have you or any member of your immediate family been a party to any lawsuit?

If so, when and in what court?

11. Are you either a close friend of or related to any law enforcement officer?
12. Has a claim for personal injuries ever been made against you or any member of your family?
13. Have you or any member of your family ever made any claim for personal injuries?

Juror’s Signature