Juror Questionnaire - Dc (Page 2 of 2) in pdf

Case 1:04-cr-00103-REB

Document 1058-3

Filed 03/20/2007

Page 2 of 2

16.This case involves allegations that the defendants engaged in fraud related to a high

yield investment program. Have you heard, seen, or read anything about this

case?________ or similar cases?__________

17. What are the three activities or hobbies in your life you like the most?____________

______________________________________________________________________

18. Are you or is anyone one close to you, an officer, director, or executive for a publicly

traded company, or an employee of a company in the private or public securities industry,

or financial services industry? If yes, please specify.____________________________

______________________________________________________________________

19. Are you now, or have you ever been licensed professionally as a certified public

accountant, securities broker-dealer, financial investment advisor, or attorney? If yes, what

field(s)?_____________________________________________

20. Have you or anyone close to you ever been charged with a crime, convicted of a crime,

or been the subject of a criminal investigation? ________Was there anything about that

experience that would affect your service as a juror on this case?__________________

______________________________________________________________________

21. Have you or anyone close to you suffered any financial loss as a result of the downturn

in the stock market in the last six years? __________

22. Do you use the services of a tax preparer to prepare and file tax returns?_________

23. Do you have any formal or informal education or training in accounting, insurance,

securities transactions, or finance? If yes, please describe the nature and extent of any

such education or training. ________________________________________________

_____________________________________________________________________

THANK YOU FOR YOUR HELP

I declare that my answers and the above information are true to the best of my

knowledge. I know that if I have willfully misrepresented a material fact on this

questionnaire, I may be guilty of and punished under federal law for perjury or making a

false statement.

Dated this _____ of April, 2007.

Signed:____________________________________

Print name:______________________________________

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Juror Questionnaire - Dc Page 2