In the event that any county of this state cannot obtain and select names for the jury pool by automated means pursuant to §22-2-304, the county may utilize the alternate jury selection method set out in this section.
To the Honorable , Presiding Judge of the Judicial District, at County:
I, , the jury coordinator for such county, and , who witnessed the selection of names, respectfully report the following names, which have been drawn according to law, arranged alphabetically and numbered, as shown on the original tickets or cards enclosed with this report, as the jury pool for the upcoming jury service term:
Names
No.
No.
No.
We further report that in addition to the above list there were drawn from the jury box at the same time the following names of persons known to the jury coordinator to be unqualified or incompetent to serve (copying such names and numbers), and we enclose such original tickets or cards with this report separate from the other tickets or cards.
This the day of , .
Jury Coordinator
Witness