Form 9-513B. Juror qualification.

[For use with Rules 5-606, 6-605, 7-605 NMRA] JUROR QUALIFICATION FORM Juror ID Number: ___________ Dear Prospective Juror: Please answer each of the following questions completely. The contact information you provide will be used only by court employees and shall not be made available to the attorneys or parties in the cases that you may be selected to hear as a juror. Estos formularios están disponibles en español en http://jury.nmcourts.gov. Si neccesita más ayuda en español, llame al número telefónico indicado en la primera página del citatorio para prestar servicio como jurado. Name as it appears on the summons: _______________________________________ Legal name: ___________________________________________________________ Salutation (optional - Ms./Mrs., Mr., or Mx.): __________________________________ Pronouns (optional - he/him/his, she/her/hers, or they/them/theirs): ________________ Mailing address: ________________________________________________________ Home address (if different): _______________________________________________ City: ________________________________ State: _____________ Zip: ___________ Phone numbers: Home: __________________________________ Business: ___________________ Ext: _________ Cell: ____________________________________ E-mail: __________________________________ 1. Do you live more than forty (40) round-trip miles from your home to the courthouse? Yes  No  If yes, what is your round-trip mileage? __________________ Would you like to be compensated for mileage? Yes  No  2. Are you employed by the public schools, local government, or the State of New Mexico? (Note: these public employees cannot be compensated by the court for their jury service.) Yes  No  3. Of which New Mexico county are you a resident? ____________________ 4. Are you a United States citizen? Yes  No  If no, country of citizenship: _________________________ 5. Will you need an interpreter? Yes  No  If yes, which language? ________________ 6. Have you ever been convicted of a felony? Yes  No  a. If yes, please explain: __________________________ b. If yes, have you completed all conditions of parole or probation? Yes  No  c. If yes, please enclose a copy of one of the following: ____ Certificate or letter of completion issued by the Department of Corrections of New Mexico, or another state. ____ Certificate or letter of pardon from the Governor of New Mexico, or another state. SELECT ONE: ____ I am available to serve for the dates listed on my summons (skip to signature, sign and return form). ____ I am requesting a postponement for the reasons noted below until the following date: ________________ (jury service may be postponed for up to six (6) months). ____ I am requesting to be excused or exempted for the reasons noted below. I am submitting the required documents. REQUEST FOR POSTPONEMENT, EXCUSAL, OR EXEMPTION If your jury service is scheduled for a date that conflicts with your schedule, please request a postponement for a more convenient time. There are NO AUTOMATIC EXEMPTIONS. All exemptions must be requested, including exemptions based on age or prior jury service. ALL situations will be considered on a case-by-case basis. Please enclose a detailed explanation for cases of: ____ Prior jury service (provide appropriate date(s) of service and court) ____ Medical (must submit a current letter on letterhead from healthcare provider) ____ Financial hardship (not being compensated by your employer is not grounds for excusal) ____ Age: _______________ (persons seventy-five (75) and older may contact the court for an affidavit form requesting an exemption) ____ Not a resident of the State of New Mexico or ____________ County (please submit proof of residency, such as a current driver’s license or a voter registration card) ____ Caregiver: _____________________ (must submit a current letter on letterhead from healthcare provider) ____ Nursing mother (a current letter on letterhead from healthcare provider required if requesting second postponement) ____ Student or teacher (request to be postponed until school breaks - please provide below the dates when your school break begins and ends): ________________________________________________________________________ ____ Other: ___________________________________________________________________ PLEASE NOTE: Unless you receive a letter from the court stating you are excused from attending jury service, you MUST appear on the date required by the court. Not showing up for jury duty when summoned is called Failure to Appear and can result in a fine of up to five hundred dollars ($500), up to six (6) months in jail, or both. Section 31- 19-1 NMSA 1978. You can call the jury division to check on the status of your excusal or postponement. I swear or affirm that the information I have provided is true and correct to the best of my knowledge. I am aware that failure to submit required documentation may result in the denial of my request. ___________________________________ Signature of prospective juror _________________________________ Date ___________________________________ Signature of the person preparing this form, if different from prospective juror _________________________________ Date Please return completed Juror Qualification and Juror Questionnaire forms to the court listed on the summons you received.