Jury Jury - North Carolina by AmericanLegalNet

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									                                                                                        File No.
 STATE OF NORTH CAROLINA

     Vs.
                                                JURY                                    Film No.




                                                BACK ROW

 1                                      2   3        4                             5                           6




 7                                      8   9        10                            11                          12




                                                FRONT ROW
                             CHALLENGES
For Cause
                                                     I certify that in the above-numbered case the persons whose names appear above were
                                                     called as jurors, that those whose names are marked through were excused, and that
State Or Plaintiff                                   those whose names are not marked through were empanelled to serve as jurors.

Defendant                                           Date               Signature                                         Dep. CSC          CSC
                                                                                                                         Asst. CSC


AOC-G-111, Rev. 2/12
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