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2. Juror Number*
3. First Name*
4. Last Name*
6. Address*
8. Is your Physical Address different than your Mailing Address?*

   1. Yes
   2. No
10. Mailing Address
12. Mileage to Municipal Court*
13. How long have you resided there?*
14. Number of Years in Montana*
16. Phone Number*
17. Email Address
18. Age*
20. Gender*

    1. Male
    2. Female
21. Marital Status*

    1. Married
    2. Single
22. Name of Spouse
23. Do you have children?*

    1. Yes
    2. No
25. Age of Children
26. Gender of Children
27. What education have you had? *

    _{Check all that apply.}

    1. High School Diploma
    2. Some College
    3. College Graduate
    4. Other, Trade/Certification
28. Are you employed at present? *

    1. Yes
    2. No
30. Occupation*

    If retired, provide last occupation

31. Employer's Name & Address
33. Spouse's Occupation

    If retired, provide last occupation. 

34. Spouse's Employer Name & Address
36. Have you ever served as a Juror?*

    1. Yes
    2. No
37. If so, in what court?
39. Have you or any member of your immediate family been injured in an accident? *

    1. Yes
    2. No
40. If so, what type?
42. Are you or any member of your immediate family involved in law enforcement in any official capacity? *

    1. Yes
    2. No
43. If so, briefly explain.
45. Have you or any member of your immediate family ever been a plaintiff or defendant in a lawsuit? *

    1. Yes
    2. No
46. What type of lawsuit?
48. Are you or your spouse related to any attorney? *

    1. Yes
    2. No
49. If so, his/her name and address.
51. Are you or your spouse presently being represented by an attorney? *

    1. Yes
    2. No
52. If so, his/her name and address.
54. Do you have any disability which you feel would make it difficult to serve on a jury? *

    1. Yes
    2. No
55. Do you feel you should be excused from serving as a juror because of undue hardship or because you do not meet the eligibility requirements for jury service?*

    1. Yes
    2. No

    If you answered "Yes", you must also complete an Affidavit for Excusal. 

56. In order to be eligible to serve as a trial juror, you must be 18 years of age or older, a resident for at least 30 days of the state and of the city, town or county in which you are called for jury duty, a citizen of the United States and not convicted of malfeasance in office or any felony or other high crime (the sentence of which has not yet expired or the fine not yet paid)
58. I certify that the foregoing statements are true to the best of my knowledge and belief.*

    1. I understand that checking this box constitutes a legal signature on the Jury Questionnaire for Kalispell Municipal Court.
59. Date*
    Date
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61. 1. Receive an email copy of this form.
62. Email address

    This field is not part of the form submission.

63. Submit

* indicates a required field