WPC ,YO+1iĈD1Er_CrRt:@Eb= 6oZ磉>CI8^sBMPumTg1a&KIL tn5}c`6`EHz!n:>\:N[f6Njh? N4\YqeT5 ֬#e2nn7}h}#0u>.Nzyc pɚ޸َ9a_!9^VK =&7cG/<2D/./xpnv1'qk? E O"/җ#UN % 0(w41"@bU@jN^  mhp photosmart 7350 seriesT(,,,,T(0(9 Z 6Times New Roman RegularX($x'63|x  X X )L  Z (CG Times RegularU6 U !  _ X_XXXXXTR[A' LegalX3' LetterA'Legal3'LetterT C@INTHEMUNICIPALCOURT X @v v CITYOF_____________,WYOMING D @WW!JURORQUESTIONNAIRE 0 PLEASEREADCAREFULLYANDCOMPLETETHEFOLLOWINGQUESTIONS.  LEAVEWITHORMAILTHECOMPLETEDFORMTO:  @#CLERKOFCOURT  @@@#MUNICIPALCOURT t @YY&(Address)  `   (CityState,Zip)  L  Icertifythefollowinginformationtobetrue: | $  1.NAMEANDAGE:________________________________________________________ h      `  First  InitialLast     x Age T  2.HOMEADDRESS:____________________________HOMEPHONE_____________ ^    IsthiswithintheCityLimitsofCheyenne?Yes_____No_____  3.YEARSOFRESIDENCE:InWyoming______InCheyenne______. z" 4.PRIORPLACEOFRESIDENCE:___________________________________________  5.MARITALSTATUS:Married_____Separated______Widower______Single______ > Ѐ(PleaseCheck)Divorced______Widow______NumberofChildren_________ H 6.YOUROCCUPATIONANDEMPLOYER:___________________________________  Ѐ______________________________________BUSINESSPHONE_______________ d  7.LISTALLMEMBERSOFYOURFAMILY(includeadultsandminors): n Relationship `  Age  Occupation     p Employer Z  ____________________________________________________________________________ " ____________________________________________________________________________ v$ ____________________________________________________________________________ & ____________________________________________________________________________ :!( ____________________________________________________________________________ "D * ___________________________________________________________________________ #!, 8.IfyouareaWIDOWorWIDOWER,giveLATESPOUSESOCCUPATIONAND `%#. EMPLOYER:_________________________________________________________________ L&#/    ` Occupation   h     Employer 8'$0 9.IfyouareRETIRED,giveYOURLASTOCCUPATIONANDEMPLOYER: (B&2 ____________________________________________________________________________ )'4 Occupation `     h     Employer *(5 10.HaveyouservedasaJURORpriortothisterm?Yes______No______. +|)6 ЀIfso,WhenandinWhatState?______________________________________________. 6-*8 11.HaveyouoranymemberofyourimmediatefamilybeenaPARTYtoANYLAWSUIT? .@,: ЀYes______No______Ifso,inwhatCourt?____________________________________. /-< 12.AreyourelatedtoorclosefriendswithanyLAWENFORCEMENTOFFICER? \1/> ЀYes______No______. 2f0@ 13.DoyouDRIVEanautomobile?Yes______No_______.  41B 14.HaveyoueverbeenCONVICTEDofaFELONY?Yes______No_______. 5*3D JURORNUMBER    h   ______________________________________ 9P7J (TobeenteredbyClerkofCourt) h   JURORSIGNATURE