Model Petit Jury Summons & Questionnaire – Pop. Less Than 1,000
Texas · Texas Judicial Branch
This form is a summons and questionnaire for people who are asked to serve on a jury. It asks for personal details, employment information, and whether the person qualifies for an exemption or is disqualified from jury service.
Where this fits in a case
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This form is used when a county with a population of less than 1,000 is calling people for jury service. The person receiving the summons must complete the questionnaire before reporting for jury service.
Either party may file.
Common questions
- Who needs to fill out this form?
- The form is for a prospective juror who has been summoned for jury service.
- What happens if I don't fill out the questionnaire?
- The instructions state that the person must complete the juror questionnaire and bring it when they report for jury service.
- Can I ask to be excused from jury service?
- The form includes sections for claiming exemptions or listing disqualifications, but the person must follow the instructions for doing so.
Revision history
No changes recorded since we started tracking this form on October 9, 2026.
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