Juror Change of Address Form

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The questionnaire below is provided for as a service to the citizens of Wayne County and should be used for official purposes only. Pursuant to Georgia laws, it is a criminal offense to use this site for deceptive or fraudulent purposes and persons doing so will be prosecuted.


Please complete all information below and submit your response by click Submit Form.
Contact Information

First Name
Middle Name/Initial
Last Name
Present Street Address
Present Mailing Address
Present City of Residence
Present State/Province
Present Zip/Postal Code
Former Street Address
Former Mailing Address 
Former City of Residence
Former State/Province
Former Zip/Postal Code
Current Work Phone
Current Home Phone
If you do not have a phone, 
state phone number where 
you can be contacted
Fax
E-mail

Personal Information


Date of Birth
Sex
Male Female
Social Security Number
 (Information is required for security purposes).


 By submitting this form, I certify this information is true and correct. I understand that providing false information will subject me to criminal penalties, as provided by the Georgia Computer Protection Act, and Georgia laws relating to providing false information to a public official.

 


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