Free Notice (Other) - District Court of Colorado - Colorado

Case 1:04-cr-00103-REB

Document 1045

Filed 03/12/2007

Page 1 of 2

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, town, or county do you live?_______________________________ 4. What is your current marital status?___________________________________ 5. Do you have any children?__________Their ages and occupations: ____________________________________________________________________ 6. Military service?_________ Branch?___________When?______________ 7. What are or were the occupations of your parents?__________________________ 8. What is the highest level of education you have completed?___________________ 9. Are you employed? _______ By whom?__________________________________ Job description:___________________________________ What is your spouse's occupation, if any?_____________________________________________________ 10. Do you regularly perform volunteer work? ________Yes _______No. If yes, what?________________________________________________________________ 11. Please list any newspapers, magazines, or TV programs you read or watch regularly:______________________________________________________________ _____________________________________________________________________ 12. Do you listen regularly to talk radio? ______ Yes ________No. What program(s)?__________________________________________________________ 13. If you have any relatives or very close friends who work in law enforcement or corrections, list the person's name, relation to you, and job: _____________________________________________________________________ _____________________________________________________________________ 14. What are the three activities or hobbies in your life you like the most?__________ _____________________________________________________________________ 15. Have you, a close friend, or any member of your immediate family ever been

Case 1:04-cr-00103-REB

Document 1045

Filed 03/12/2007

Page 2 of 2

employed by the United States government, any state or local government, the Federal Bureau of Investigation, the Internal Revenue Service, or the Securities and Exchange Commission? _____ Which agency?_______________________________________. 16. Have you, a close friend, or any member of your immediate family ever had an experience with the FBI, IRS, SEC, or the Colorado Division of Securities which has caused you to have animosity or a bad feeling toward any of these agencies?______. If yes, please explain:____________________________________________________ 17. Have you read, seen, or heard anything about any of the defendants (Norman Schmidt, George Alan Weed, Charles Lewis, or Michael Smith), or the entities (including the Reserve Foundation Trust, Smitty's, Capital Holdings, or Monarch Capital Holdings) in this case?__________________________________________________ 18. This case involves allegations that the defendants engaged in fraud related to a high-yield investment program. Have you read, seen, or heard anything about this case? _________ or similar cases?________________________________________ 19. Are you now, or have you ever been professionally licensed as a securities brokerdealer, financial investment advisor, or attorney? If yes, what field?________________ _____________________________________________________________________ 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 ever been a victim of crime? ___Yes ___ No. When?_______What was the crime?____________________________________________________________ Was there anything about that experience that would affect your service as a juror on this case?_____________________________________________________________ _____________________________________________________________________ 22. Do you have any formal or informal education or training in accounting, insurance, or securities transactions? If yes, please describe the nature and extent of any such education or training_____________________________________________________ _____________________________________________________________________ Under penalty of perjury, I swear or affirm that my answers to the foregoing questions are truthful to the best of my knowledge. Dated this ________of April, 2007. Signed:_________________________________ Print name:_____________________________