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S.B. 796 VETOES
IF YOU ARE OVER 70 YEARS OF AGE, DO YOU WISH TO BE EXEMPTED FROM JURY
SERVICES? ____YES ____NO
U.S. CITIZEN? ____YES ____NO
ABLE TO COMPREHEND, READ, SPEAK, AND WRITE
ENGLISH? ____YES NO
EDUCATION: _______________________________________________________________
OCCUPATION OF PROSPECTIVE JUROR: ________________________________________
OCCUPATION OF SPOUSE, IF ANY:_____________________________________________
DISABILITY PREVENTING SATISFACTORY JURY SERVICE? ____YES ____NO
PENDING CHARGE FOR A CRIME PUNISHABLE BY IMPRISONMENT EXCEEDING 1 YEAR
6 MONTHS? ____YES ____NO
CONVICTION OF CRIME PUNISHABLE BY IMPRISONMENT EXCEEDING 1 YEAR 6
MONTHS AND RECEIVED A SENTENCE OF IMPRISONMENT FOR MORE THAN 6
MONTHS AND NOT LEGALLY PARDONED? ____YES ____NO
DATE OF CONVICTION__________________________________________________________
ARE YOU CURRENTLY:________ INCARCERATED______REQUIRED TO REGISTER
AS CHILD SEXUAL
ON PAROLE--------------------OFFENDER, OFFENDER,
SEXUALLY VIOLENT
ON PROBATION---------------OFFENDER OR SEXUALLY
VIOLENT PREDATOR
____ ELECTED OFFICIAL OF THE FEDERAL LEGISLATIVE BRANCH, AS DEFINED IN 2
U.S.C, § 30A,
____ ACTIVE DUTY MEMBER OF ARMED FORCES EXEMPTED IN ACCORDANCE WITH
10 U.S.C. § 982.
____ MEMBER OF MARYLAND'S ORGANIZED MILITIA EXEMPTED IN ACCORDANCE
WITH PUBLIC SAFETY ARTICLE § 13-218.
PRIOR JURY SERVICE WITHIN 3 PRECEDING YEARS:_____________________________
FORM COMPLETED BY ME ____ANOTHER (NAME)___________________ AND,
IF ANOTHER, WHY?
UNDER THE PENALTIES OF PERJURY, THE RESPONSES ARE TRUE TO THE BEST OF MY
KNOWLEDGE
SIGNED:___________________________________________________________________
PROSPECTIVE JUROR
INDIVIDUAL COMPLETING FORM FOR PROSPECTIVE JUROR THIS FORM MUST BE
COMPLETED, SIGNED, AND RETURNED THE JURY COMMISSIONER WITHIN 10 DAYS
AFTER RECEIPT. DOCUMENTATION FOR EXCUSAL DUE TO DISABILITY, EXEMPTION
BASED ON ARMED FORCES OR MILITIA SERVICE, PARDONS, AND/OR PRIOR JURY
SERVICE MUST BE ATTACHED.
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