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Jury Questionnaire

The following "Juror Questionnaire" is mandated by Government Code, Section 62.0132

Your answers are CONFIDENTIAL under Government Code, Section 62.0132, and may only be disclosed to the judge, court personnel, the litigant, and the litigant's attorney.

* Denotes a required field

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*Jury Summons Number Please enter all 15-17 digits

*Last Name

*First Name

Middle Name

*Date of Birth (Format MM/DD/YYYY)

*Age

*Race Asian
Black
Indian
Middle Eastern
Multiracial
Native Hawaiian or Other Pacific Islander
Other
American Indian/Alaska Native
White

*Sex Male
Female

*Home Address

*City

*State

*Zip

Mailing Address (If Different)

*County Of Residence

*Home Phone

*Mobile Phone

*E-Mail

*Preferred Method Of Contact Home
Cell/Text
E-mail

*Your Occupation

*Your Employer

*How Long?

*Current Marital Status Single
Married
Widowed
Divorced

Spouse's Name

Spouse's Occupation

Spouse's Employer

How Long?

*Are you a U.S. Citizen? Note: If you state that you are not a U.S. citizen, you may no longer be eligible to vote and may be required to provide proof of U.S. citizenship to your county voter registrar.
Yes
No

*Highest Level Of Education Completed No H.S. Diploma or GED
GED
H.S. Diploma
2yr College
4yr College/University
Post-Graduate
Other

*Number of Children

Age Ranges

Have you ever served on a civil jury?

Have you ever served on a criminal jury?

QUALIFICATIONS FOR JURY SERVICE (Texas Government Code, Section 62.102) If you do not meet all of the below qualifications you cannot serve. Mark any that do not apply to you.
Be at least 18 years of age
Be a citizen of the United States
Be a resident of Chambers County TX
Be qualified under the Constitution and laws to vote in Chambers County TX (Note: you do not have to be registered to vote to be qualified to vote)
Be of sound mind and good moral character
be able to read and write the English language
Not have served as a juror for six days preceding three months in the County Court or during the preceding six months in the District Court and
Not have been convicted of or under indictment or other legal accusation for misdemeanor theft or a felony.

EXEMPTIONS FROM JURY SERVICE (Texas Government Code, Section 62.106) You may choose an exemption but are not required to.
You are over 70 years of age and would like to claim a permanent exemption
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 without adequate supervision
You are a student at a public or private high school
You are enrolled and in actual attendance at an institution of higher education
You are an officer or an employee of the 1)Senate 2)House of Representatives or any 1)Department 2)Commission 3)Board 4)Office or 5)Other agency in the legislative branch of state government
You are the primary caretaker of a person who is unable to care for themselves (This exemption does not apply to you if you are a primary caretaker only in your capacity as a health care worker.)
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 of residence.

*Payment for first day of jury empanelment is $10.00. Do you wish to: Donate to the Chambers County Child Welfare Board
Donate to the Chambers County Fallen Officer's Memorial Fund
Donate to the Texas State Crime Victims Compensation Fund
Cash

*I certify that all answers are true and correct E-sign box

Chambers County Seal

Chambers County
404 Washington Avenue
Anahuac, Texas 77514
Phone: (409) 267-2400
Hours: Monday - Friday
8:00 AM-12:00 PM
1:00 PM-5:00 PM

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Disclaimer

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