PUYALLUP MUNICIPAL COURT JUROR RESPONSE TO SUMMONS

2. First Name*
3. M.I.
4. Last Name*
6. Per RCW 2.36.070, I am competent to serve as juror, as I am;*

   1. 1. (18) Eighteen years or older
   2. 2. A United States Citizen
   3. 3. A resident of the City or live within Zip Code served by the City
   4. 4. Am able to communicate in the English Language
   5. 5. I have never been convicted of a felony; or have had civil rights legally restored
8. I am qualified to serve as a juror*

   1. Yes
   2. No
10. IF NO, please explain:
12. IF YOU CHECKED YES AND ARE QUALIFIED PLEASE CHECK THE DELCARATION BELOW:
14. DECLARATION OF JUROR QUALIFICATION

    1. I hereby declare, under penalty of perjury of the laws of the State of Washington, that I have reviewed the above JUROR QUALIFICATIONS and am qualified to serve.

    If you were able to check all five boxes above.
16. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
18. Electronic Signature*
19. Date*
    Date
21. Email Address*
22. Phone Number*
Leave This Blank:


24. 1. Receive an email copy of this form.
25. Email address

    This field is not part of the form submission.

26. Submit Submit and Print

* indicates a required field