{
  "document_metadata": {
    "page_number": "28 of 40",
    "document_number": "365",
    "date": "10/22/21",
    "document_type": "Jury Questionnaire",
    "has_handwriting": false,
    "has_stamps": false
  },
  "full_text": "Case 1:20-cr-00330-PAE Document 365 Filed 10/22/21 Page 28 of 40 Juror ID: DECLARATION I, Juror Number declare under penalty of perjury that the foregoing answers set forth in this Jury Questionnaire are true and correct to the best of my knowledge and belief. I have not discussed my answers with others, or received assistance in completing the questionnaire. Signed this day of November, 2021 DO NOT WRITE YOUR NAME. PLEASE SIGN USING YOUR JUROR NUMBER. -27- DOJ-OGR-00005304",
  "text_blocks": [
    {
      "type": "printed",
      "content": "Case 1:20-cr-00330-PAE Document 365 Filed 10/22/21 Page 28 of 40",
      "position": "header"
    },
    {
      "type": "printed",
      "content": "Juror ID:",
      "position": "header"
    },
    {
      "type": "printed",
      "content": "DECLARATION",
      "position": "top"
    },
    {
      "type": "printed",
      "content": "I, Juror Number declare under penalty of perjury that the foregoing answers set forth in this Jury Questionnaire are true and correct to the best of my knowledge and belief. I have not discussed my answers with others, or received assistance in completing the questionnaire.",
      "position": "middle"
    },
    {
      "type": "printed",
      "content": "Signed this day of November, 2021",
      "position": "middle"
    },
    {
      "type": "printed",
      "content": "DO NOT WRITE YOUR NAME. PLEASE SIGN USING YOUR JUROR NUMBER.",
      "position": "middle"
    },
    {
      "type": "printed",
      "content": "-27-",
      "position": "footer"
    },
    {
      "type": "printed",
      "content": "DOJ-OGR-00005304",
      "position": "footer"
    }
  ],
  "entities": {
    "people": [],
    "organizations": [
      "DOJ"
    ],
    "locations": [],
    "dates": [
      "10/22/21",
      "November, 2021"
    ],
    "reference_numbers": [
      "1:20-cr-00330-PAE",
      "365",
      "DOJ-OGR-00005304"
    ]
  },
  "additional_notes": "The document appears to be a jury questionnaire declaration page. It is a printed form with blank spaces for the juror to fill in their ID number and signature date. There is no handwritten text or signatures on this page."
}