Juror Change of Address Form

The questionnaire below is provided for as a service to the citizens of Liberty County and should be used for official purposes only. 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.

Please complete all information below and submit your response by click Submit Form.

Contact Information

First Name

Middle Name/Initial

Last Name

Present Street Address

Present Mailing Address

Present City of Residence

Present State/Province

Present Zip/Postal Code

Former Street Address

Former Mailing Address

Former City of Residence

Fomer State/Province

Fomer Zip/Postal Code

Current Work Phone

Current Home Phone

If you do not have a phone,
state phone number where
you can be contacted

FAX

E-mail

Personal Information

Date of Birth Day

Month

Year

Sex Male Female

Social Security Number (Information is required for security purposes).

By submitting this form, I certify this information is true and correct. I understand that providing false information will subject me to criminal penalties, as provided by the Georgia Computer Protection Act, and Georgia laws relating to providing false information to a public official.

First Name
Middle Name/Initial
Last Name
Present Street Address
Present Mailing Address
Present City of Residence
Present State/Province
Present Zip/Postal Code
Former Street Address
Former Mailing Address
Former City of Residence
Fomer State/Province
Fomer Zip/Postal Code
Current Work Phone
Current Home Phone
If you do not have a phone, state phone number where you can be contacted
FAX
E-mail

Date of Birth	Day
	Month
	Year

Sex	Male Female

Social Security Number	(Information is required for security purposes).