Northern District of Mississippi

JURY LIST REQUEST FORM

The list of prospective jurors will be available 1 week before trial. Please complete and return this form via e-mail to Renee_Moore@msnd.uscourts.gov . Or you may fax your request to 662-236-4550.

Please note that the pool of jurors on the list will consist of names who are to report that day for all trials scheduled at the courthouse and not just for your specific case. Therefore the list may consist of those who will not be one of your potential jurors.

This jury list is CONFIDENTIAL and should be destroyed at the conclusion of the trial.

Person requesting jury list: __________________________________________________

Phone number: ___________________________________________________________

Attorney: ________________________________________________________________

Date of trial: _____________________________________________________________

Location of trial: __________________________________________________________

Case No.: ________________________________________________________________

Select method of delivery:

□	Fax: _______________________________________________

□	E-mail: _____________________________________________

□	To be picked up by: ___________________________________