Fla. R. Civ. P. Form 1.984

As amended through May 30, 2024

Form 1.984 - JUROR VOIR DIRE QUESTIONNAIRE

JURY QUESTIONNAIRE

Instructions to Jurors

You have been selected as a prospective juror. It will aid the court and help shorten the trial of cases if you will answer the questions on this form and return it in the enclosed self-addressed stamped envelope within the next 2 days. Please complete the form in blue or black ink and write as dark and legibly as you can.

1. Name (print)________________________________________

(first)

(middle)

(last)

2. Residence address________________________________________

3. Years of residence: In Florida________________________________

In this county_____________________________

4. Former residence____________________________

5. Marital status: (married, single, divorced, widow, or widower)

6. State the highest level of education you completed

________Less than high school	______________Some college
_____________High school	___________________Associate degree
________________Vocational/Technical school	_______________College degree
__________________Post graduate degree

7. Your occupation and employer__________________________

8. If you are not now employed, give your last occupation and employer____________________

9. If married, name and occupation of husband or wife_______________

10. Have you served as a juror before?_____________________

11. Have you or any member of your immediate family been a party to any lawsuit?______________________________________________

If so, when and in what court?_________________________________

12. Are you either a close friend of or related to any law enforcement officer? __________________________________________

13. Has a claim for personal injuries ever been made against you or any member of your family? ________________________________________

_____________________________________________________

14. Have you or any member of your family ever made any claim for personal injuries? ________________________________________

_____________________

Juror's Signature

FL. R. Civ. P. Form 1.984

Amended by 292 So. 3d 660, effective 1/1/2020; added by 253 So.2d 404, effective 12/31/1971.

NOTE: This form does not have a caption as shown in form 1.901, but should be headed with the name of the court summoning the juror.