22 CRR-NY D VI Form 10NY-CRR
22 CRR-NY D VI Form 10
22 CRR-NY D VI Form 10
10 Juror questionnaire
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: ______
22 CRR-NY D VI Form 10
Current through May 31, 2021
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