§ Form 1.984 Juror Voir Dire Questionnaire

Form 1.984. Juror Voir Dire Questionnaire

JURY QUESTIONNAIRE

Instructions to Jurors

You have been selected as a prospective juror. It will aid the court and help shorten the trial of cases if you will answer the questions on this form and return it in the enclosed self-addressed stamped envelope within the next 2 days. Please complete the form in blue or black ink and write as dark and legibly as you can.

1. Name (print) _______________________________________

(first) (middle) (last)

2. Residence address __________________________________________________________

3. Years of residence: In Florida ___________________________

In this county ___________________________

4. Former residence ___________________________________________________________

5. Marital status: (married, single, divorced, widow, or widower)_____________

6. Your occupation and employer________________________________________________

7. If you are not now employed, give your last occupation and employer_________

8. If married, name and occupation of husband or wife__________________________

9. Have you served as a juror before?__________________________________________

10. Have you or any member of your immediate family been a party to any lawsuit?______If so, when and in what court?

11. Are you either a close friend of or related to any law enforcement officer?

12. Has a claim for personal injuries ever been made against you or any member of your family?

    13. Have you or any member of your family ever made any claim for personal injuries?
                                                                                                                ______________________________________
                                                                                                                Juror's Signature

NOTE: This form does not have a caption as shown in form 1.901, but should be headed with the name of the court summoning the juror.