Juror Summons For Circuit Court printable pdf download

STATE OF SOUTH CAROLINA

JUROR SUMMONS FOR CIRCUIT COURT

FOR TERM

JUROR

COUNTY OF

BEGINNING

NUMBER:

WEEK OF:

You are hereby summoned to appear at _______________ on ___________________________, at _____ to answer this

summons to serve as a (check applicable box)

petit juror

for the Court of Common Pleas and General

grand juror

Sessions. Failure to appear at the address above at the specified time may subject you to penalties as prescribed by

law.

CLERK OF COURT,

Phone

NAME AND ADDRESS OF JUROR

IMPORTANT INFORMATION AND INSTRUCTIONS

Fill in the requested information in the “Juror Information

Section” and the appropriate contact information below. After

reading all of the conditions listed in the “Juror Response

Section,” mark any condition that applies to you. Separate the

top and bottom portions of this page at the line indicated below

and WITHIN THREE DAYS OF RECEIPT return the bottom

portion of the form using the self-addressed envelope provided.

NOTE: PERSONS FAILING TO RETURN THESE FORMS AS REQUESTED MAY BE SUBJECT TO CHARGES OF CONTEMPT OF COURT.

Separate this top portion from bottom portion at the dotted line. Retain this top portion for your reference.

Return this bottom portion as instructed using the self-addressed envelope provided.

JUROR INFORMATION SECTION

FOR TERM

JUROR

BEGINNING WEEK

NUMBER:

(PLEASE PRINT OR TYPE CLEARLY.)

OF:

CITY, COUNTY, STATE OF BIRTH

AGE

YEAR OF BIRTH

# OF CHILDREN MARRIED

SINGLE

WIDOWED DIVORCED

YOUR OCCUPATION

PRESENT OR FORMER EMPLOYER

YEARS

LEVEL OF FORMAL EDUCATION COMPLETED

NAME OF SPOUSE

SPOUSE’S OCCUPATION

SPOUSE’S PRESENT OR FORMER EMPLOYER

YEARS

HAVE YOU EVER SERVED ON A

HAVE YOU EVER BEEN A PARTY TO A CIVIL LAWSUIT?

YES

CIVIL JURY, OR

CRIMINAL JURY?

HAVE YOU EVER BEEN CONVICTED OF A CRIME (OTHER THAN A MINOR TRAFFIC OFFENSE)?

YES

IF SO, WHEN?

NAME AND/OR ADDRESS CORRECTION: If the information below is incorrect, please write in the correct information in the space provided to the left.

INFORMATION BELOW WILL BE MADE AVAILABLE ONLY TO OFFICERS OF THE COURT.

PHONE #

BUSINESS PHONE #

ALTERNATE PHONE #

EMERGENCY PHONE # E-MAIL ADDRESS

Retain the top portion of this form for your reference and return the bottom portion of the form along with any required affidavits or

JUROR RESPONSE

written statements in the self-addressed envelope provided.

SECTION

INSTRUCTIONS

NOTE: Unless the clerk of court otherwise notifies you, you must report for jury duty as requested.

DISQUALIFICATIONS

EXEMPTIONS

I am not a U.S. citizen.

I am 65 years of age or older and wish to be excused. (If you do not wish to

serve on a jury, you may telephone the clerk of court to be excused. Unless

I am not a resident of this county. (Note correct address above.)

I cannot read, write, speak, or understand the English language.

you are excused by the clerk of court prior to the term for which you are

Translator’s name and telephone #:

summoned, you must report for jury duty.)

I am the primary caretaker of a disabled person or a person age 65 or older who

I have less than a sixth grade education or its equivalent.

cannot care for

himself.***

I have a mental or physical condition that prevents me from serving

I have legal custody and duty of care of a child under the age of seven and I

as a juror. (Doctor’s statement required)

cannot provide adequate childcare while serving as a

juror.***

I have been convicted in a state or federal court of a crime that

I am a guard, keeper, employee, or other officer at a state penitentiary.

carries a sentence of more than one year of imprisonment and I

I have served on a circuit court jury during the previous two calendar years, or I

have not been pardoned or given amnesty for that conviction. List

have served on a grand jury during the previous four calendar years. Date of

offenses, when and where convicted:

Service:

County:

Jury Type:

Circuit Court

Grand Jury

I am a clerk of court, deputy clerk of court, constable, sheriff,

I am a student or a school employee and wish to be transferred to a later date

commissioned law enforcement officer, probate judge, county

that will not conflict with my school term.

commissioner, magistrate, or county officer, or I am employed

Date Available for Service:

within the walls of a courthouse. Occupation:

[When you return this form, you must also send evidence of school enrollment or

employment.]

I have served on a circuit court jury within this calendar year.

***An affidavit (notarized statement) must be returned with this form attesting to the

Date of Service:

County:

above statements.

I HAVE READ THE CONDITIONS FOR DISQUALIFICATION AND EXEMPTION ABOVE AND NONE OF THE CONDITIONS LISTED APPLY TO ME.

NOTE: THE FURNISHING OF FALSE OR MISLEADING INFORMATION OR THE FAILURE TO FURNISH INFORMATION TO THE COURT MAY SUBJECT YOU TO

PENALTIES AS PRESCRIBED BY LAW.

YOUR SIGNATURE _______________________________________________________

SCCA 235 (11/2016)

NOTE: Participation of all eligible citizens as jurors is encouraged. If you need specific accommodations, courthouse staff will be available for assistance.

Juror Summons For Circuit Court

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