Liberty County

In addition to the general Juror Questionnaire you received from the Office of the Clerk of Superior Court, please complete this additional questionnaire for Grand Jurors. The questions asked must be answered prior to jury selection in order to determine if you are legally eligible to serve as a grand juror.

---

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) Date of Summons?
	(c) Juror Number? (see top of summons):

2.	Have you resided in Liberty County for at least six months prior to the date for which you have been summoned for service as a grand juror?	YesNo
3.	Are you the holder of any elective office in state or local government or have you held any such office within two years prior to the time your proposed service as a grand juror? Please state what office you hold or have held:	YesNo
4.	Are you 18 years of age or older? Please indicate your birth date: Month    Day    Year	YesNo
5.	Are you a convicted felon? If so, when and where (city and state) were you convicted?	YesNo
6.	If you are convicted felon, has your civil rights been restored?	YesNo
7.	Have you ever been determined by a court to be mentally incompetent?	YesNo

---

Thank you for taking the time to answer the questions in this Grand Jury 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