JURY QUESTIONNAIRE

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Name:___________________________________ ___________________Address: ________________________________________ ____________Email Address:________________________________ _______________ Home Phone:__________________Work Phone: __________________Cell Phone: ____________________Date of Birth: ____________________Age: ________To receive text notifications, list the cell phone carrier:Marital Status:_____________________________Age( s) of Children:_________________________Number of Children:__________________Spouse s Name:____________________________Spouse s Occ:________________________Spouse s Emp:_____________________________Occupat ion:_________________________Employer: ________________________________Level of Education: ________________________Are you a United States Citizen?

* There is not an exemption from jury service based solely on age. Exemptions must be based on some other good cause. An example of good cause would be pursuant to Iowa Code section 235F.1 concerning a “vulnerable elder;” “Vulnerable elder” means a person sixty years of age or older who is unable to protect himself or herself from

  Questionnaire, Exemption