Jury Summons By Order Of The Presiding Judge Page 3
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7JUROR ELIGIBILITY FORM
Circuit Court of the State of Oregon for Multnomah County
Juror Number: 9999999
Panel ID: 4003
Service Start Date: 11/09/2012
*9999999*
INSTRUCTIONS:
Unsigned forms cannot be used by the Court.
You must answer, to the best of your knowledge, each of the questions or requests for information in sections 1 and 2, and any
that are applicable in section 3.
SECTION 1: ELIGIBILITY
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If you answered "no" on question 1, 2 or 3, or answered "yes" on question 4 or 5, then you are not eligible to serve at this time and only need
to sign the declaration and mail in this form. You may not serve as a juror on the date set.
SECTION 2: PRIOR CONVICTIONS MAY AFFECT ELIGIBILITY FOR CRIMINAL PROCEEDINGS ONLY
but you remain eligible to serve as a juror in a civil
trial and must report on the date set.
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not eligible
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eligible
SECTION 3:
Juror Compensation (Information sheet item 13):
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one way
Hearing Impaired Assistance Needed (Information Sheet Item 3):
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Delay of Jury Service (Information Sheet Item 7):
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Mandatory grounds which the Court must grant if you ask to be excused (Information Sheet Item 8):
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SECTION 4: DECLARATION
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