On-Line Jury Card Form for Justice of the Peace #3

 


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Please fill out the information below and click the submit button.  If you fill out and submit this online form you no longer need to mail back the paper form. 

While filling out this form you can advance through the form by pressing the TAB button on your keyboard or use your mouse.  DO NOT Press the RETURN button on your keyboard.  This will submit the form.  If you do, you can use the back button in your browser to get back to the form.  Complete the form and resubmit.

You will find two or three sets of numbers on the top right of your jury card.  Please include ALL the numbers in the first space on this form!  There is an example below.

 

When filling out this form

DO NOT PRESS ENTER

to advance to the next space.

 That will submit the form.

 
Juror Number (add all sets of numbers from the card):   Example: 78, 051510JP3, 3155966
Full Name:
Current Address:
City/Zip:
County:
Home Phone:
Age:
Email:
Employer:
Occupation:
Work Phone:
How Long at Job:
Spouse's Name:
Spouse's Employer:
Spouse's Occupation:
How Long at Job:
Highest Level of Education Completed:
Marital Status (S M W D):
Gender (Male Female):
Race (Required by law):
Number of Children:
Age Range of Children:
To be qualified to serve as a juror, you must:

  

General Qualifications for Jury Service:  (Government Code, Section 62.102)

  1. Be at least 18 years of age;
  2. Be a citizen of this state and of the county in which you are to serve as a juror;
  3. Be qualified under the Constitution and law to vote in the county in which you are to serve as a juror;
  4. Be of sound mind and good moral character;
  5. Be able to read and write;
  6. Not have served as a juror for 6 days during the preceding 3 months in the county court or during the preceding 6 months in the district court; and
  7. Not be convicted of, or be under indictment or other legal accusations for, misdemeanor theft or a felony.
Yes, I Qualify to Serve No, I Don't Qualify to Serve

 
You may be exempted from jury service if:     Exemptions: Section 62.106 Government Code of Texas
  1. You are over 70 years of age;  Remove me permanently?  Yes No
  2. You have legal custody of a child or children younger than 15 years of age and service on the jury would require leaving the child without adequate supervision;
  3. You are a student at a public or private high school;
  4. You are enrolled and in actual attendance at an institution of higher education;
  5. You are an officer or an employee of the senate, the house of representatives, or any department, commission, board, office, or agency in the legislative branch of the state government;
  6. You are the primary caretaker of a person who is an invalid unable to care for himself or herself (This exemption does not apply to health care workers);
  7. You are a member of the United States military forces serving on active duty and deployed to a location away from your home station and out of your county residence.

Yes, I'm Exempt No, I'm Not Exempt

 
If you claim not to be qualified to serve, or you claim to be exempt from jury duty, please explain.

 
Have you ever served on a Civil Jury: Yes No
Have you ever served on a Criminal Jury: Yes No
 

 
 

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