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:

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)

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

2. Birth date:
 
3. Are you a resident of Liberty County?
 

If not a resident of Liberty County, please specify the county and state where you reside:
County
State
 
4. What is your mailing address?
  Street/P.O. Box
  City
  State
  Zip Code
 
5. What is your race?
(Information required by law)
 
If race is Other, please state:
 
6. Are you Hispanic/Latino?
 
 
7. What is your gender?
 
 
8. What are your phone number(s)?:
  (Home)
  (Work)
  (Cell)
  (Other)
 
9. Where were you born (City/State)?
 
 
10. Who is your employer?
 
  Years worked there?
  What is your type of work?
 
11. If married, please name your spouse:
 
  If applicable, name of spouse's employer:
  Years worked there?
  Type of work?
 
12. Have you ever served as a juror?
 
If yes, what type of case?
 
13. Has a claim of personal injury ever been made against you or a family member?
 
 
14. Have you ever been the victim of a crime?
 
If yes, when?
  And what crime(s)?
 
15. Have you or any member of your family ever been a party to a law suit?
 
If yes, when?
  In which court?

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SECTION B -- Juror Exemptions

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

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

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?
 
 
2.
 
3. 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.
 
  College/High School Name:
 
 
4. Please enter any additional comments concerning any of the questions above or this survey.
 
 
5. What is your E-Mail address?
 

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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
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).



  

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