Official Jury Summons

2. This is for the convenience of our County Residents who need to take a qualification and/or exemption. Please fill out the summons and click submit.

4. Lea Carlson
   District Clerk
   1111 E. Yellowjacket Ln., Ste. #101
   Rockwall County, TX 75087

6. IMPORTANT - PLEASE READ
   Dear Prospective Juror: YOU ARE HEREBY SUMMONED TO APPEAR FOR JURY DUTY SERVICE ON THE DATE AND TIME SPECIFIED BELOW:

8. IMPORTANT
   Call (972) 204-6601 after 5:00 pm on the last working date prior to your scheduled appearance for recorded instructions.

10. SUMMONS NO.*

11. Date of Appearance*

13. IMPORTANT: Please carefully read all information.

15. Answer all questions below. Bring entire summons with you to court. Please print legibly. You are to appear promptly as instructed by this summons. If you have a special need or disability you are encouraged to notify the court immediately concerning request for reasonable accommodation. THE FOLLOWING "JUROR QUESTIONNAIRE" IS MANDATED BY GOVERNMENT CODE, SECTION 62.0123.
    Your answers are CONFIDENTIAL and may be disclosed only to the judge, court personnel, the litigant, and the litigant's attorney.

17. JURY QUESTIONNAIRE

19. Are you a U.S. Citizen?*

    1. Yes
    2. No

20. Gender*

    1. Male
    2. Female

22. Race (required by State Law)*

23. Age*

24. Date of Birth*

26. Your Name*

27. Home Address*

29. City*

30. State*

31. Zipcode*

33. Mailing Address (if different from home)

35. City

36. State

37. Zipcode

39. Home Phone*

40. County of Residence*

41. Email Address:*

43. Your Occupation*

44. Work Phone*

46. Your Employer*

47. How Long?*

49. Spouse's Name

50. Spouse's Occupation

52. Spouse's Employer

53. How Long?

55. Have you ever served on a civil jury?*

    1. Yes
    2. No

56. Have you ever served on a criminal jury?*

    1. Yes
    2. No

58. Current Martial Status*

    1. Single
    2. Married
    3. Widowed
    4. Divorced

59. Number of Children*

60. Ranges of Age (from ___ years to ___ years)*

62. Please check the highest level of education completed?*

    1. Did not receive H.S, Diploma?
    2. H.S. Diploma
    3. GED
    4. 2 yr. College
    5. 4 yr. College
    6. Post Graduate
    7. Other

64. AFFIDAVIT AND CERTIFICATION OF EXEMPTION OR DISQUALIFICATION FORM

66. IF CLAIMING AN EXEMPTION OR DISQUALIFICATION, CHECK THE CORRESPONDING BOX.

    Exemptions*

68. (Gov't Code, Section 62.106)

70. You may be exempted from jury service if (select one that applies):*

    1. You are over 70 years of age
    2. You have legal custody of a child or children younger than 12 years of age and service on the jury would require leaving the child or children 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 other agency in the legislative branch of state government
    6. You are the primary caretaker of a person who is unable to care for himself or herself (this exemption does not apply if you are a primary caretaker only in your capacity as a health care worker.)
    7. You are a member of the United States military forvces serving on active duty and deployed to a location away from your home station and out of your county of residence
    8. I am not claiming an exemption, I am claiming a disqualification

72. (Gov't Code, Section 62.102)

74. To be qualified to serve as a juror you must (select one disqualification):*

    1. Be at least 18 years of age
    2. Be a citizen of the United States
    3. Be a resident of this state and of the county in which you are to serve as a juror
    4. Be qualified under the Constitution and laws to vote in the county in which you are to serve as a juror (Note: You do not have to be registered to vote to be qualified to vote)
    5. Be able to read and write
    6. Not have served as a juror for six days during the preceding three months in the county court or during the preceding six months in the district court; and
    7. Not have been convicted of, or be under indictment or other legal accusation for, misdemeanor theft or a felony
    8. I am not claiming a disqualification, I am claiming an exemption

76. *You are not required to claim an exemption. It is your choice.

78. BUSINESS REASONS ARE NOT LAWFUL EXCUSES

80. I, do hereby certify under penalty of perjury that I am*

    1. Exempt because of the reason(s) marked above
    2. Disqualified because of the reason(s) marked above
82. If claiming an exemption for person over 70 years of age please check if this exemption is

    1. Temporary Exemption
    2. Permanent Exemption

84. If you need to contact us for information other than exemptions and qualifications,
    Click Here

86. I CERTIFY THAT ALL ANSWERS ARE TRUE AND CORRECT. If yes, then submit this form.

Leave This Blank:


87. 1. Receive an email copy of this form.
88. Email address

    This field is not part of the form submission.

89. Submit Submit and Print

* indicates a required field