No. The Juror Qualification Questionnaire is used to determine whether you are qualified to serve as a juror. It is not a jury summons. Please complete the questionnaire and return it promptly in the enclosed self-addressed stamped envelope (SASE), or complete it online via the Jury Portal.

On Question #2, check “No” for Hampshire County residency, sign the questionnaire, and return it in the provided SASE.

We apologize for the inconvenience. Please write “Deceased” on the questionnaire and return it in the provided SASE.

Potential jurors are selected from DMV records and voter registration records. If those records have not been updated, a deceased person’s name may still appear in the jury pool. To update records: Voter registration: Hampshire County Clerk’s Office — (304) 822-5112 Driver’s license records: DMV — (304) 822-3123

At the top of the questionnaire, enter your birth date. If you are 70 or older, you may request to be excused from jury service by checking the box next to your birth date. Important: If you do not check the box requesting to be excused, you will remain qualified as a potential juror and may be called to serve.

Question #5 on the second page asks for dates when you are unavailable. List all dates during the four-month jury term for which you cannot serve. Jury terms begin in January, May, and September, and each term lasts four months. The dates you provide will be entered as conflict dates, so you will not be called during that time.

If a medical condition prevents you from serving, please provide a signed excuse from your physician. The excuse may be mailed, faxed to (304) 822-8257, or delivered in person. Please also complete, sign, and return your questionnaire. If your doctor’s excuse is being sent separately, note this on Question #2 of the second page and indicate how it will be submitted (mail, fax, or in person). Important notes: A doctor’s excuse excuses you for that four-month term only. Medical excuses are not permanent. If you are called for a future term and still cannot serve, you must submit a new doctor’s excuse.

Question #1 on the second page asks whether you have previously served as a juror. You are disqualified from serving only if you served on a jury panel and were paid for that service within the last two years. If you only reported for jury selection but were not selected to serve on a jury, you are not disqualified.

Use Questions #3 through #6 on the second page to explain your situation and request an excuse. After your questionnaire is returned, your request will be reviewed by the Chief Circuit Judge. You will be notified by phone or mail if your request is approved.

Please return the questionnaire as soon as possible. We understand that emergencies, travel, or other circumstances can cause delays, but it is important that the form be completed and returned promptly.

If you misplaced your questionnaire, contact the Hampshire County Circuit Clerk’s Office to request a replacement, or use the printable questionnaire available on our website. If you are unsure whether your questionnaire was for Grand Jury or Petit Jury, please contact the office for assistance.