Adams Cnty. C.P. Rules of Civil Procedure Rule 220

A. Court Administration shall devise a juror qualification form limited to questions sufficient to

determine a person’s qualification to serve as a juror as required by 42 Pa.C.S.A. §4521(d)(1). The

juror qualification form shall be in a format that substantially allows for responses to the following

questions:

1. Are you a resident of Adams County?

2. Are you a citizen of the Commonwealth of Pennsylvania?

3. Can you read, write and understand the English language?

4. Have you been convicted of a crime punishable by imprisonment for more than one year and

not granted a pardon or amnesty?

5. Are you incapable, by reason of mental or physical infirmity, to render efficient jury service?

6. Are you 18 years of age or older?

B. The juror qualification form shall include a signature line for which the person completing the

form declares under penalty of perjury that the responses to the questions on the form are true to

the best of the person’s knowledge.

C. The questions outlined in this Rule and the responses contained therein from prospective

jurors shall constitute in whole a completed juror qualification form, and only this form shall be made

available to the plaintiff or if represented, plaintiff’s attorney and defendant or if represented, defendant’s

attorney upon request.