SUMMONS and TRIAL JUROR QUALIFICATION FORM OFFICIAL COURT D O CUME NT

ALL INFORMATION REQUESTED ON THE JUROR QUALIFICATION FORM PART B MUST BE PROVIDED

By order of the Montgomery ColBlty Circuit Court you are hereby SUMMONED for jury duty Marylands jury selection law provides that jurors are selected at random from a fair cross section of citizens residing in Montgomery County Under this law your name has been selected from a consolidated list of registered voters from the Board of Elections and licensed drivers or identification card holders from the Motor Vehicle Administration Your answers to the questions on the Juror Qualification Form will be evaluated to make sure you are eligible for jury service In general you must be at least 18 years of age a citizen of the United States a resident of Montgomery County and be able to communicate in English Any citizen selected for a jury serves for the duration of one trial however long that trial may be Most trials last no more than three days and an occasional trial will last a week or more Anyone not selected for a jury is dismissed at the end of the day

The Court adheres to a very strict excusal and rescheduling policy Any request to be excused or rescheduled from jury service must be submitted in writing to the Jury Office within 1 Odays of receipt of this Summons along with your completed Juror Qualification Form and any required documentation Maryland law recognizes no exemptions on the basis of occupation

Please be assured that the Court will make every effort to assist you in performing your responsibilities as a juror and to make your service as convenient as possible Jury Service is an important constitutional right as well as a duty of citizenship and we thank you for your participation For more information please visit our website wwwmontgomerycountymdgovcircuitcourt or contact the jury office at 240-777-9090 between 900 am to 400 pm Monday through Friday

PART A - WHAT TO DO M ONTGOMERY COUNTY ADMINISTRA11YE JUDGE

STEP 1 - Read both sides of this document fully It is both a SUMMONS for Jury Service and a Juror Qualification Form

STEP 2 - YOU MUST Complete Juror Qualification form within 1 O days of receipt by one of the following two methods

a Return the completed Juror Qualification Form (Part BJ and all required documentation by US mail to the Jury Office OR

b Complete online at wwwmontgomerycountymdgovcircuitcourt A STEP 3 - Follow the Reporting Instructions as noted on the SUMMONS below A ~ STEP 4 - Bring your SUMMONS with you when you report for Jury Service ~

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PARKING AND PUBLIC TRANSPORTATJO~ See jury website for parking directions for jurors who serve DO NOT use metered parking Public transportation is convenient to the Court and is encouraged For information regarding public transportation in Montgomery County call 240-777-7433

INCLEMENT WEATHER POLICY

In the event of inclement weather please call 240-777-9399 or go to wwwmontgomerycountymdgovcircuitcourt the morning you are scheduled to appear for weather related updates If the information has not changed report as scheduled You may also follow updates on local television news and radio stations

JUROR ENTRANCE

Jurors are to enter via Maryland Avenue or Monroe Street 03-1981

1 111igti TRIAL JURY SUMMONS 11111111111111111111111111111111111111111111111111 REPORTING INSTRUCTIONS Any citizen selected for a jury serves for the duration of one trial however long that trial may be Most trials last no more than three days and an occasional trial will last a week or more Anyone not selected for a trial may be dismissed at the end of the first day

All jurors must call the juror information line at 301-309-9351 or visit the jury website at wwwmontgomerycountymdgovcircuitcourt after 500 pm on the evening before your date of service to determine whether you need to report on your service date If your number does not fall within the range of numbers called in you need not report The recorded information is updated daily at 500 pm and it is important that you check ALL reporting instructions

NO weapons of ANY kind are permitted on the premises of the courthouse Possession and use of cell phones and other electronic devices are limited or prohibited in designated areas of the court facility

PROPER ATIIRE is required No uniforms shorts t-shirts with logos athletic wear or tank tops No provisions are available for child care Jurors may bring meals and medication Accommodations to refrigerate items are available as is free Wi-Fi

JUROR BADGE ID 1111 tg

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middot CALL-IN NUMBER 274

SERVICE DATE 07-1l-2017 TIME 830AM

REPORT TO Montgomery County Circuit Court 50 Maryland Avenue Room 2100 North Tower Rockville Maryland 20850

ALL JURORS MUST CALL 301-309-9351 OR VISIT wwwmontgomerycountymdgovcircuitcourtjurors AFTER 500 PM THE EVENING BEFORE DATE OF SERVICE TO CONFIRM YOUR SERVICE

Complete on-line at httpmdcoudsgovjwy or complete PART B and return by US mail PART B - JUROR QUALIFICATION FORM

All sections must be completed thoroughly fallure to do so may result In further court action 1 Last Name First Name Ml 2 Gender 3 Date ofBirth Age f

D Male Month QLoayQLYear CJ~Do-e a Female

4 ResidentAddress 5 Contact Information Home Telephone 2 lt - 4 So - 1- f 9 0

State

YO Zip Code Work Telephone i1 -=1 - J1 - 1J1=3= Ol0 8 SD

1 Cell Telephone 2 22 shy 222 shy 2- 2 22

1 Email Jon-ltl)ae ema i Imiddot Com

ii Employed 0 Unemployed D Retired

9 Spouses Occupation

Your 10 Education D Did not receive HS diploma 0 High School or GED D 2 year College Olr 4 year College 0 Graduate School Other

Answer statemcm (l 1-23) by checking the appropriate Yes or No box then sign date and mumPAln B to the Jury Office (See Documentation Code Legend below for additional imtruction(s)

Yes No 11 a or Cl I am a United States citizen (cdeA) 12 a or Cl I am a primary resident ofthis county (Code B) 13 Zit or Cl I am able to read write speak and comprehend the English language (Code C) 14 Cl or lSI I am under 18 years ofage (Code B) 15 Cl or a I have pending charges against me punishable by a sentence exceeding 6 months (cde D) 16 Q or Iii I have been convicted ofa crime and sentenced to more than 6 months imprisonment and have not been legally pardoned (Code I) 17 Cl or 51 I need an accommodation in accordance with the Americans with Disabilities Act (eg sign language inteipreter etc) (Code F) 18 Cl or Ill I have a disability that prevents satisfactoxy completion ofjuxy service (Code G) 19 Cl or llil I have served as a trial or grand juror within the last three years (Please note an individual who serves on a jmy for fewer than 5 days in a 3-year

period can be summoned for jmy service after one year) Indicate dates served (Cede B)

20a Cl or Iii am 70 years ofage or older and wish to be temporarily exempt (or excused) from juxy service (Code H) 20b Cl or 18 I am 70 years ofage or older and wish to be permanently exempt (or excused) from jury service (Cecle B) 21 Cl or lli I am an active duty member ofthe armed forces and request an exemption in accordance with 10 USC Section 982 (Code I) 22 Q or 51 I am a member ofMarylands organized militia and request an exemption in accordance with Public Safety Article Section 13-218 (Cecle I) 23 Cl or ~ I am an elected member ofthe federal legislative branch and request an exemption in accordance with 2 USC Section 30A (Code J) If for any otha reason you feel you should be cxcuaed ftom service follow Code J instructiom below H you have a significant sclgttAtnling conftict (ie prepaid vacation business trip etc) you may take advantage of a one-time courtesy taehcduling on our website at hUyJmdcomUgov~ Aampmatively you may submit a written rcqnest with your completed questionnaire You will receive written notification ifyour mJUesf iJ granted or denied I hereby certify under penalty ofperjury that my responses to the above questions are true to the best ofmy knowledge

Signature ofProspective JurorJ=CUR -Oee_ Date Of- ~ 0 r~0 3shySignature ofIndividual Completing Form for Prospective Juror (See Code C-------------Date-------- shy

-Detach the upper portion of this form and return to the Jury Office Pfease save the fower portion to bring wtth you when reporting for jury duty shy

OFFICIAL COURT DOCUMENT Any person who falls to report for jury service or submit juror qualification information either online or using the Juror Qualification Form) within 10 days after receipt of this summons or willfully misrepresents a material fact on a Juror Qualification Form for the purpose of avoiding or obtaining service as a juror may be subject to a fine andor imprisonment in accordance with Md Code Ann CTS AND JUD PROC Art Sec 8-503

State Law prohibits discrimination or retaliation against an employee for taking time off to serve as a juror Employers may not require an employee to use annual sick or vacation leave to respond to a summons for jury service Md Code Ann CTS AND JUD PROC Art Sec 8-501 and Sec 8-502 Documentation Code Legend If documentation is required you must send it in along with the Juror Qualification Fann (PART B)

Code A - If NO A copy of your resident alien card green card student visa or work visa is required

Code B - If NO A copy of your new drivers license or MVA issued state ID are acceptable to document your new address If you do not have these fonns of identification contact the jury office from which you received the summons

Code C - If NO to Question 13 OR if you are assisting an individual with the completion of the Juror Qualification Fann then A letter of explanation is required including a signature from the person assisting you with filling out the form Please note the relationship to the individual summoned

Code D - If YES A copy of the charges or a letter listing the charges dates and the jurisdiction where the charges are pending is required

Code E - If YES A copy of the charges or a letter of explanation listing the charges the sentence the date and the jurisdiction where you were convicted is required

Code F - If YES A written statement requesting an accommodation and specifying the type needed is required

Code G - If YES A written signed statement from your health care provider explaining that you are not able to satisfactorily perfonn jury duty even with a reasonable ADA accommodation and indicating the length of time you will be disabled is required

Code H - If YES You will receive notice from the court officially excusing your service

Code I - If YES A copy of your military orders a copy of a letter from your commanding officer or a completed Certification of Military Exemption Fonn must be provided to the Court The Fonn can be found at httprndcourtsgovjury (DO NOT include social security number)

Code J - If YES A letter of explanation is required

Please visit lsttp1114colll1sgovmy for additional information about jury service in Maryland