Form 4-602C NMRA. — Juror questionnaire.

[For use with Rules 1-047, 2-603, 3-603 NMRA]

JUROR QUESTIONNAIRE FORM

Juror ID Number: ________________

Please answer all questions, 1-20, and SIGN. The Juror Questionnaire will be provided to the attorneys, parties, and judges in all cases you may be selected to hear as a juror. The answers you provide will aid in the process of selecting a jury. If you do not understand a question, please place a question mark (?) next to the question. If you do not have enough room to answer the question, please use the space provided after question 20 or a separate sheet of paper. If there is a question you would rather discuss with the judge and attorneys in private, please indicate with an asterisk (*). Thank you for your cooperation.

1. Salutation (optional - Ms./Mrs., Mr., or Mx.), legal name, and former names:

________________________________________________________________

________________________________________________________________

2. Pronouns (optional - he/him/his, she/her/hers, or they/them/theirs) and gender:

________________________________________________________________

________________________________________________________________

3. Birth year: _________________

4. What is your race or ethnic background? _______________________________

5. In which Neighborhood and/or Area do you live? _________________________

Where else have you lived (city, state, country)? _________________________

6. What is your marital status? Single Married Domestic partner Separated Divorced Widowed

7. If you are married or in a domestic partnership, please provide spouse's/partner's full name and occupation. ________________________________________________________________

________________________________________________________________

8. Do you have any children or step children? Yes No

How many? ______ ages ___________ occupations____________________

9. Name of current or most recent employer and place of work: ________________

Occupation/job title and duties: _______________________________________

Dates of employment: ______________________________________________

10. How many years of schooling have you completed? ______________________ Highest level completed/degree ______________________________________

Major areas of study: ______________________________________________

11. Do you belong to or participate in any religious, civic, social, union, professional, fraternal, political, or recreational organizations? Please list all:

________________________________________________________________

12. Current political party affiliation: ______________________________________

13. Have you or any member of your immediate family been the victim of a crime?

Yes No If yes, who was the victim? _____________________________

What crime? _____________ When? ___________ Was an arrest made?

Yes No

14. Have you ever served as a juror? Yes No

(If yes, please check) Grand Jury Civil Criminal

15. Have you or anyone close to you ever sued anyone, or been sued?

Yes No

If yes, please explain: ______________________________________________

16. Have you or an immediate family member ever been an agent, employee, or representative of an insurance company? Yes No

17. Have you or an immediate family member been a defendant in a criminal case?

Yes No

If yes, please explain: ______________________________________________

18. Have you or any family member ever been employed by a Court, law enforcement agency, jail or prison, or any attorney's office?

Yes No

If yes, name of employer: ___________________________________________

19. Do you have a physical or mental disability of which we need to be aware? Yes No

Are you presently taking any medication that may affect your ability to serve as a juror? Yes No

If yes, are there any special accommodations, services, or assistance we can provide during your jury service? ________________________________________________________________

20. Is there any reason you could not serve as a juror? Yes No (If you are requesting an excusal or postponement for this reason, you must complete and submit the Request for Postponement, Excusal, or Exemption Form)

If yes, please explain: ______________________________________________

Use this space for any additional comments: ____________________________

________________________________________________________________

________________________________________________________________

I SWEAR OR AFFIRM THAT THE INFORMATION I HAVE PROVIDED IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF.

__________________________________________ _________________________________ Signature of prospective juror, or preparer (if different Date than prospective juror)

[Approved by Supreme Court Order No. 17-8300-016, effective December 31, 2017; as amended by Supreme Court Order No. 19-8300-022, effective December 31, 2019; as amended by Supreme Court Order No. S-1-RCR-2024-00063, effective for all cases pending or filed on or after October 7, 2024.]