R. vs. ROBERT LATIMER
Section 235 (1) C. C.
Queen's Bench Jury Trial November 7, 1994

JURY LIST BACKGROUND CHECK
JUROR # ______________

NAME: _____________________________ DOB: _________ FPS:________

ADDRESS: _________________________________________________________

CRIMINAL RECORD: _______________________________________________
(Description)
PIRS: __________________________________ INDICES: _____________

MARRIED / SPOUSE _______________________ DOB: _______ FPS: _______
(Name, G1/Maiden)

DEPENDANTS: #1 __________________________________________________
#2 __________________________________________________
#3 __________________________________________________
#4 __________________________________________________

RELIGION ___________________________ STRONG _______ WEAK _____
PROLIFE ____________ PRO-CHOICE __________

ANY FAMILY DISABILITIES: (Describe) _____________________________
__________________________________________________________________
__________________________________________________________________

ANY DISABLED CLOSE ASSOCIATES: (Describe) _____________________
___________________________________________________________________
___________________________________________________________________
(Adult or children)

VOLUNTEER ORGANIZATIONS/MEMBERSHIPS: ______________________
___________________________________________________________________
___________________________________________________________________
(Eg. - Telemiracle, Voice of the Handicap, Sarcan, etc. )

MERCY KILLING OPINION: IF ANY:_________________________________
__________________________________________________________________

OTHER COMMENTS: ______________________________________________
_________________________________________________________________