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Personal Information

First Name
Last Name
Address
City
State
Zip Code
If the information above is different from the summons you received in the mail, please provide the address listed on the summons:
Name / Address on Summons
It is important that you provide a phone number where we can contact you if there are any changes to your jury service. Phone numbers are for court personnel use only and are not given to attorneys or their clients.
Home Phone
Business Phone
Cell Phone
Receive Texts?
1. Yes
1. No
Date of Birth
Date of Birth
Age
If you live outside the city limits of El Dorado, what is your round-trip mileage from your home to the courthouse?
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I swear or affirm under the penalties of perjury that the above statements, representations, and answers are true to the best of my knowledge and belief.
Electronic Signature of Juror

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