Jury Questionnaire | Kathryn Strong | Sumner County Circuit Court Clerk

DO NOT FILL OUT THIS FORM IF YOU NEED TO POSTPONE YOUR SERVICE, IF YOU NEED TO BE EXCUSED FROM JURY DUTY OR IF YOU DO NOT QUALIFY AS A JUROR. If you need to postpone your jury service, do not qualify as a juror or need to request to be excused, please submit the form under the "Request a Postponement", "Jury Disqualification Form" or "Request for Undue Hardship" tabs. Thank you.

First and Last Name - As Listed on the Summons

Current Name - If different from above

Street Address

City

Zip Code

Date of Birth

Cell Phone

Email Address

Confirm Email Address

Employer

Occupation

Spouse's Name

Spouse's Employer

Spouse's Occupation

Number of Children (including adult children)

List Dates You Can't Serve During the Month - You can be excused for up to 7 days during the month for travel, doctor's appointments, work obligations, etc. If you need more than 7 days off , you must postpone your jury service.

I, the undersigned juror, hereby make oath or affirmation under penalty of perjury that I am qualified to serve as a juror in Sumner County, Tennessee. Qualification being that I am a US Citizen, I have never been convicted of a felony or a crime of dishonesty, I am a resident of the state of Tennessee, I am a resident of Sumner County and have been for at least 12 months. **If these statements are not accurate, do not submit this form. You must complete the Jury Disqualification Form.**

I, the undersigned juror, hereby make oath or affirmation under penalty of perjury that the information provided is true and accurate to the best of my knowledge.

Date