4/11/2016 JurorOnlineQuestionnaire

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YOUR RESPONSE INDICATES THAT YOU ARE NOT ELIGIBLE TO SERVE AS A JUROR AT THIS TIME. Please be aware that the Jury Management Office will review your
responses and may ask for verification regarding the information you've provided. Do not report for juror service on your summons date unless you are contacted
further by the Jury Management Office.

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County: MIDDLESEX Juror #: 0314 Name: INABEN KUMARPATEL Participant #: 102233838 Report Date: 5/25/2016 Date Submitted:
4/11/2016 Record Id: 3067796
1. Are you a resident of the above county? Yes
2. Are you a citizen of the United States? No
3. Are you mentally and physically able to properly perform the functions of a juror? Yes
4. Have you ever pleaded guilty or been convicted of an indictable offense? No
If Yes, state the charge:
and the year:
5. Are you 18 years of age, or older? Yes
6. Can you read and understand English? Yes
7. Telephone (Home: If none, nearest phone): 7323182494
8. Work: /Ext.
9. Date of Birth: 197061
10. Are you employed fulltime by the State of New Jersey? No
11. Name of your employer? (If self employed, type "self") h.k mobiles
12. What is your occupation?
Reason for postponement:
Request to be excused for age?

Name / Address Changes

Name Change (First Last) :
Address Change (Street, Apt):

City/State: ,
Email Address
Email Address:
(By providing your email address, you consent to receiving information regarding your jury service.)
IMPORTANT: Signing up for this service will not provide you with information regarding last minute weather
related or emergency court closings.
Text Messaging OptIn
Cell Number: 7323182494
Yes, I would like to receive text messages
IMPORTANT: Signing up for this service will not provide you with information regarding last minute
weather related or emergency court closings.
Reference
Pool No: 012160517 Qualification: 4, 4/5/2016, 6 Your Email: Certified:

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