Juror Questionnaire - Dc printable pdf download

Case 1:04-cr-00103-REB

Document 1058-3

Filed 03/20/2007

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IN THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF COLORADO

Case No. 04-cr-00103-REB

JUROR QUESTIONNAIRE

1. Name:_______________________________________

2. Age:______________

3. In what city or town and county do you live?_________________________________

4. How long have you been a resident of Colorado? _____________

5. What is your current marital status? ____________

6. Do have any children? ___________Their ages and occupations: _______________

______________________________________________________________________

7. Military service?______ Branch?___________ When?________________________

8. What are or were the occupations of your parents?___________________________

9. What is the highest level of education you have completed? ___________________

10. Are you employed?____By whom?_______________________________________

Job Title?______________________________________________________________

11. Have you or anyone close to you ever had a serious negative experience with a

business organization?________ What business?______________________________

12. Have you or anyone close to you ever been accused of misconduct in connection with

business or investment activities? Who:________________________________________

13. Have you ever lost any part of your investment or retirement funds because of the

alleged wrongdoing of another? _________

14. Have you read, seen, or heard anything about any of the defendants (Norman Schmidt,

George Weed, Charles Lewis, or Michael Smith) in this case?________________

15. Have you, a close friend, or any member of your immediate family ever been

employed by the United States government, any state or local government, the Federal

Bureau of Investigation, the Internal Revenue Service, the Securities and Exchange

Commission, or the Colorado Division of Securities?_______ Who:________________

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Juror Questionnaire - Dc