Jury Disqualification Form | Kathryn Strong | Sumner County Circuit Court Clerk

To qualify as a juror in Sumner County you must: 1) Be a resident of Tennessee and Sumner County for at least the past 12 months, 2) Be a US Citizen, 3) Have never been convicted of a felony or other crime of dishonesty which includes check fraud, shoplifting, other fraud, etc.). If you do not qualify as a juror, you must complete the form below and submit the required documentation. If you have questions, please call our juror coordinator (615) 934-5120 or send an email to [email protected].

First and Last Name - As Listed on the Summons

Date of Birth

Address

City, State and Zip Code

Email Address

Phone Number

Disqualification Cause

Felony Conviction Information

Supporting Documentation

You must provide proof of non-citizenship, residency in another state, or residency in another county - This can include resident card, driver's license, lease agreement, utility bill or other documentation showing your name and current address
Files must be less than 20 MB.
Allowed file types: gif jpg jpeg png txt rtf html pdf doc docx.

I certify I completed the Disqualification Form truthfully. I understand that it is a Class A Misdemeanor for which I can be sentenced to jail for up to 11 months and 29 days or be fined up to $2,500.00 or both if I intentionally or knowingly misrepresent, falsify, or withhold any information.

Date