Form Center

2. City of Midland Municipal Court- Jury Service

   Please fill out the following questionnaire to assist the Court and counsel in selecting a jury. The purpose of these questions is not to ask unnecessarily about personal matters. It is simply to determine whether a perspective juror can decide the case fairly and impartially. Counsel may ask more questions should you be selected for Voir Dire. This questionnaire will not be made public.

4. First Name*
6. Last Name*
8. Juror Number*

   (Located on postcard received; above your name)

10. Date of Jury Service*
12. Address 1*
14. City*
16. State*
18. ZIP Code*
20. Email*
22. Phone*
24. Preferred Method of Contact

    1. Telephone

    1. Email

26. If you agree to report for Jury Service, it is not necessary for you to claim an exemption. However, if you qualify for an exemption from Jury Service and wish to be excused, you may establish your exemption without appearing in person by filling out the information below.

     

    If you do not claim a statutory exemption, you should report for jury service as ordered by this summons.

     

    Business and employment reasons are not lawful excuses.

28. A person qualified to serve as a juror may claim an exemption from jury service. Please select one of the following exemptions below:

    1. Is over seventy (70) years of age
    2. Has legal custody of a child younger than 12 years old and Jury Service would require leaving the child or children without adequate supervision
    3. Is a student of a public or private secondary school
    4. Is enrolled and in actual attendance at an institution of higher education
    5. Is the primary caretake of an invalid unable to care for themselves.
    6. Does not live within the city limits of the City of Midland. Note: a person claiming an exemption based on citizenship or residency in the county might not be eligible to vote in the county.
30. I certify that the above statement and information is true and correct*
Leave This Blank:


32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit

* indicates a required field