Office of the Clerk of Courts

Liberty County
GEORGIA
Superior Court, State Court, Juvenile Court, and Magistrate Court
Post Office Box 50
Hinesville, Georgia 31310-0050

F. Barry Wilkes
Clerk and Court Administrator

Phone 912-876-3625 · Jury-Trial Status Line 912-369-JURY (5879) · FAX 912-369-5463

Electronic Juror Questionnaire Form

Complete the following questionnaire instead of a paper Form 2 if you have been summoned for jury duty. You must complete all required fields. Pursuant to Georgia laws, it is a a criminal offense to use this site for deceptive or fraudulent purposes and persons doing so will be prosecuted.

For information and facts about jury duty, please click here: Juror Information and Facts.

The purpose of this survey is to collect information about you to (1) keep our files updated, (2) to determine that you are still eligible for jury duty; and (3) to help speed up the jury selection process on the date you are summoned for jury service. ONLY PERSONS WHO ARE RESIDENTS OF LIBERTY COUNTY, GEORGIA, ARE ELIGIBLE TO SERVE AS JURORS IN LIBERTY COUNTY. If the information you provide indicates that you are eligible to serve according to Georgia law, a follow-up questionnaire may be sent to you to allow you to provide additional information for the Liberty County Jury Commission.

This survey is divided into the following sections:

Section A - Personal Information
Section B - Juror Exemptions (reasons why you may not be eligible to serve according to law)
Form Submission

Fill out the information in each section as requested. Then at the end of the form supply your E-Mail address, and submit the form. You will receive a confirmation message from us shortly.

To submit a Change of Address, click here.

SECTION A -- Personal Information

Please provide information in the spaces provided below.

1 (a) Name:

Last Name
First Name
Middle Name
Lineage (e.g., Jr., Sr., II, III)

1	(b) Juror Number? (see top of summons):
	(c) Court?
	(d) Court Date?

Birth date:
Are you a resident of Liberty County?

NoYes
If not a resident of Liberty County, please specify the county and state where you reside:
County State

What is your mailing address?

Street/P.O. Box

City

State

Zip Code

What is your race? (Information required by law)

If race is Other, please state.

Are you Hispanic/Latino?

NoYes

What is your gender?

What is your phone number(s)?:

(Home)
(Work)
(Cell)
(Other)

Where were you born (City/State)?

Who is your employer? Years worked there? What is your type of work?

If married, please name your spouse: If applicable, name of spouse's employer: Years worked there? Type of work?

Have you ever served as a juror? NoYes If yes, what type of case?

Has a claim of personal injury ever been made against you or a family member? NoYes

Have you ever been the victim of a crime? NoYes If yes, when? And what crime(s)?

Have you or any member of your family ever been a party to a law suit? NoYes If yes, when? In which court?

Back to Top

SECTION B -- Juror Exemptions

The following questions pertain to information required by Georgia law for every juror. Please answer each question.

Have you ever been convicted of a felony (serious criminal offense)?

Yes
No
If convicted of a felony, when and where?

Conviction year Where convicted (state/county)

If convicted of a felony, were your civil rights ever restored?

Yes
No
I am 70 years old or older and do not desire to serve as a juror. Please send me necessary forms to complete.
If you want to defer your jury service to a later date, check the appropriate block below.
Note that you must send additional documentation in certain circumstances.

I am on active duty status in the United States armed forces and stationed more than 50 miles from Liberty County.
I have a physical or mental disability that may impair my ability to serve as a juror. (You must obtain an affidavit from a doctor/psychiatrist detailing your medical problem or disability. I am attending the following named high school or the institution of higher learning at this time and must attend classes at this time: College/High School Name: I have a child(ren) under the age of six (6) for whom I provide sole and exclusive care and no one else is available to provide care.
I do not speak and/or understand the English language good enough to serve as a juror.
Please enter any additional comments concerning any of the questions above or this survey.
What is your E-Mail address?

Back to Top

Thank you for taking the time to answer the questions in this Jury Qualification Questionnaire. To submit your responses, click below on the Submit Form button.

Declaration and Signature of Juror

Agreed to Terms

I declare under penalty of law that I have examined this questionnaire response form and, to the best of my knowledge and belief, it is true, complete, and correct.
I understand that I may be held in contempt of court for willfully delivering false information to the court.

(By entering your name, you are signing this document).

Back to Top

Jury Information and Facts

Jury Laws and Procedures

Electronic Juror Questionnaire Form

SECTION A -- Personal Information

Back to Top

SECTION B -- Juror Exemptions

Back to Top

Back to Top

F. Barry Wilkes Copyright © 1997 [Clerk of Superior Court, Liberty County, Georgia]. All rights reserved. Revised: May 14, 2008.

F. Barry Wilkes
Copyright © 1997 [Clerk of Superior Court, Liberty County, Georgia]. All rights reserved.
Revised: May 14, 2008.