Juror Summons For Magistrate Court

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STATE OF SOUTH CAROLINA
JUROR SUMMONS FOR MAGISTRATE 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 juror for the Magistrate Court. Failure to appear at the address above at the specified time
may subject you to penalties as prescribed by law.
Judge/Court Administrator:
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 to the address listed below.
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 to _________________________ Magistrate Court, _________________________________________________, SC __________ within 3 days.
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
NO
CIVIL JURY, OR
CRIMINAL JURY?
HAVE YOU EVER BEEN CONVICTED OF A CRIME (OTHER THAN A MINOR TRAFFIC OFFENSE)?
YES
NO
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 court administrator otherwise notifies you, you must report for jury duty as requested.
DISQUALIFICATIONS
EXEMPTION
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
I am not a resident of this county. (Note correct address above.)
a jury, you may telephone the clerk of court to be excused. Unless you are excused
I cannot read, write, speak, or understand the English language.
by the clerk of court prior to the term for which you are summoned, you must report
Translator’s name and telephone #:
for jury duty.)
I have served as a grand juror during the past five calendar years.
I have less than a sixth grade education or its equivalent.
Date of Service: ____________________ County: _______________________
I have a mental or physical condition that prevents me from serving as a
MAY BE EXCUSED
juror. (Doctor’s statement required)
I am the primary caretaker of a disabled person or a person age 65 or older who
I have been convicted in a state or federal court of a crime that carries a
cannot care for
himself.***
sentence of more than one year of imprisonment and I have not been
I have legal custody and duty of care of a child under the age of seven and I cannot
pardoned or given amnesty for that conviction. List offenses, when and
provide adequate childcare while serving as a
juror.***
where convicted:
I perform services for a business, commercial, or agricultural enterprise, and my
services are so essential to the operations of the business, commercial, or
I am a clerk of court, deputy clerk of court, constable, sheriff,
agricultural enterprise, the enterprise must close or cease to function while serving as
commissioned
law enforcement
officer,
probate judge,
county
a
juror.***
commissioner, magistrate, or county officer, or I am employed within the
I am a guard, keeper, employee, or other officer at a state penitentiary.
walls of a courthouse. Occupation:
I am a student or a school employee and wish to be transferred to a later date that
I have served on a magistrate court jury within this calendar year.
will not conflict with my school term.
Date Available for Service:
Date of Service:
County:
[When you return this form, you must also send evidence of school enrollment
or employment.]
***An affidavit (notarized statement) must be returned with this form attesting to
the 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 722 (12/2016)
NOTE: Participation of all eligible citizens as jurors is encouraged. If you need specific accommodations, courthouse staff will be available for assistance.

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