Please note: the page will print without the top and left navigation bars and in black and white only.
If someone has died, you should note it on the Questionnaire next to their name and, if available, enclose a copy of a Certificate of Death and return in the envelope provided. We apologize for any distress this document may have caused.
If you have a physical or mental disability or medical condition which does not allow you to serve as a juror, you should mark the “Yes” box with an “X” in Question 5 of the questionnaire.
If you are randomly selected for jury service, a judge will decide whether your request for accommodation will be granted. Every effort will be made to provide necessary accommodations for people with disabilities to serve on a jury. For example: use of personal assistive devices, sign language interpreters, or other supports.
If you think that any of these or other accommodations would make it possible for you to serve on a jury, your answer to this question should be "No”.
If two people with the same name live at the same address and both are over the age of 18, only one person needs to complete the form.
If two or more persons at a household have received the questionnaire, each person must complete and return the form.
If you are unable to complete the questionnaire yourself, you may have someone help you and sign it on your behalf noting at the bottom of the questionnaire their relationship to you.
Yes. If the return date for the completed questionnaire is past due, complete the form as soon as possible and return it in the envelope provided.
If your address is incorrect or has changed from the address shown on the form, make corrections in the space to the right of your old address then complete and return the questionnaire.
If you have misplaced your envelope and need the return mailing address for the completed questionnaire, it is:
Sheriff’s Office c/o Provincial Jury Centre
P.O. Box 666, Station A
If the person named on the questionnaire is not living at the address shown on the questionnaire, or is living away from home for school, you can note this on the space next to the address and return the questionnaire in the envelope provided.
For comments or additional questions related to jury duty, please email email@example.com