Huron County Common Pleas: Grand Jury Questionnaire

Judge James W. Conway

Thank you for supporting Huron County's justice system.

Please answer all questions completely. Sign and submit this questionnaire within seven (7) days.

Questionnaire Date

Dec 26, 2024

I NO LONGER LIVE IN HURON COUNTY

Last Name *

First Name *

Middle Initial

New Address *

Apt

New City *

State *

New Zip Code *

Questionnaire for Grand Jury Service

Last Name *

First Name *

Middle Initial

Age *

Address *

City *

State *

Zip code *

Home Phone *

Work Phone *

Cell Phone *

Maritial Status *

Your Occupation *

Name your current employer, or if retired your former employer *

Spouse's Name (type NA if Not Applicable) *

Spouse's Occupation (type NA if Not Applicable) *

Have you ever been convicted of a felony? *

Do you have any impairment of your eyesight or hearing? *

Last time served on Jury *

Additional Remarks *

Request to be excused/postponed from grand jury service
Even if you are requesting to be excused or postponed you still need to complete the top section "Questionnaire for Grand Jury Service"

Interests of the public will be materially injured by your having to perform jury service. Please explain:

Your spouse or a near relative has recently died or is dangerously ill.
Send physician's statement to the Court of Common Pleas

You are a cloistered member of a religious organization.

Jury service requires you to abandon a person under your personal care of supervision.
Send physician's statement to the Court of Common Pleas

You are over 75 years of age and request to be excused.

You suffer from a mental/physical condition making you unable to perform jury service.
Send physician's statement to the Court of Common Pleas

You have had jury service within twelve months prior to receiving this jury service notification.

You will be out of the county on one or more weeks for which you are scheduled for jury duty. Please state which weeks, where you will be and the reason:

If you wish to have your jury duty postponed to a different term of court, please state the reason(s) for the postponement:

Additional Comments:

Your Name *

Under penalty of Purjury the information provided above is true (if the person signing is not the prospective juror, please indicate your relationship to the prospective juror next to your signature).

BY TYPING MY NAME ABOVE AND SUBMITTING THIS FORM I ACKNOWLEDGE THAT I HAVE READ, UNDERSTOOD AND AGREE TO THE ABOVE STATEMENTS.