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New York Codes Rules Regulations (Last Updated: March 27,2024) |
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TITLE 22. Judiciary |
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Subtitle D. Forms |
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Chapter VI. Forms for Use in Courts Exercising Criminal Jurisdiction |
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10 Juror questionnaire |
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Sec. 270.15 C.P.L. FORM 10 (Juror Questionnaire) 10/85 JUROR QUESTIONNAIRE YOU HAVE BEEN SELECTED TO SERVE AS A PROSPECTIVE JUROR. THIS QUESTIONNAIRE IS DESIGNED TO ASSIST COUNSEL AND THE COURT IN SELECTING FAIR AND IMPARTIAL JURORS. PLEASE ANSWER ALL OF THE FOLLOWING QUESTIONS ON THE FORM: HOWEVER, IF THERE IS INFORMATION THAT YOU WOULD PREFER TO KEEP CONFIDENTIAL, ASK TO SPEAK PRIVATELY TO THE JUDGE. THANK YOU FOR YOUR COOPERATION. 1. Name 2. Sex 3. Place of birth 4. Current address 5. How long have you lived at your current address? How long have you lived in this county? 6. Marital status 7. Years of education or highest degree obtained 8. Occupation 9. Are you presently employed? 10. Spouse's occupation 11. Is your spouse presently employed? 12. Number of ages of children 13. Are any of your children presently employed? 14. Occupations 15. Have you ever served on a state or federal grand jury? _ yes _ no Have you ever served on a state or federal trial jury? _ yes _ no If yes, state type of case (criminal or civil) Did case reach a verdict? _yes _no Most recent date of jury service______ 16. Have you, any relative or close friend ever been any of the following: (a) The victim of a crime _yes _no (b) Witness to a crime _yes _no (c) Accused of a crime _yes _no (d) Convicted of a crime _yes _no (e) Party to a civil case _yes _no 17. Have you, any relative or close friend ever been employed by any law enforcement agency or criminal justice agency? _yes _no 18. Do you have any mental or physical condition that would prevent you from serving as a juror? _yes _no 19. Do you have any difficulty reading, understanding or speaking the English language? 20. There is a possibility you may be required to stay overnight in a hotel during deliberations. Is there any reason why you feel you could not stay overnight if required and if you are given a day's advance notice? If after completing this questionnaire you feel you should not sit on this case for any other reason, please bring it to the judge's attention when your name is called. AFFIRMATION I AFFIRM THAT THE STATEMENTS MADE ON THIS QUESTIONNAIRE ARE TRUE AND I UNDERSTAND THAT ANY FALSE STATEMENTS MADE ON THIS QUESTIONNAIRE ARE PUNISHABLE UNDER ARTICLE 210 OF THE PENAL LAW. Signature of Prospective Juror Dated: ______ |