Table Of Content

Case: 1:10-cr-00387-SL Doc #: 632-1 Filed: 01/17/12 1 of 11. PageID #: 12935 JUROR NUMBER _________ JUROR QUESTIONNAIRE 1. Age ____ Gender: Male  Female  2. Date of birth: _____/_____ /_____ Birthplace (City and State): ______________________ Month Day Year 3. Please indicate your marital status:  Single and never married  Currently married  Single, but previously married  Single, but living with non-marital companion  Widowed 4. Have you ever served in the armed forces? Yes  No  If yes, which branch? ________________________________________________________ 5. What is the extent of your formal education? ___________________________________________________________________________ 6. What degrees or certificates, if any, do you hold? ___________________________________________________________________________ 7. What is your current occupation, job title and employer? ___________________________________________________________________________ (a) For how long have you been so employed? _____________________________________ (b) Please briefly describe your job duties: ________________________________________ (c) Do you supervise others? Yes  No  If yes, how many? _____ (d) Have you ever been responsible for hiring or firing employees? Yes  No  (e) What were your previous occupations? ________________________________________ (f) If you are not currently employed outside the home, what were your last employer, job title, job duties and approximate dates of employment? ______________________________ ___________________________________________________________________________ (g) If retired, state your last employer and occupation: _______________________________ ___________________________________________________________________________ 8. Current occupation, job title and employer of your spouse or companion: _______________ __________________________________________________________________________ How long has he/she held this position? _____________ Case: 1:10-cr-00387-SL Doc #: 632-1 Filed: 01/17/12 2 of 11. PageID #: 12936 9. What degrees or certificates, if any, does your spouse or companion hold? _______________ ___________________________________________________________________________ 10. Ages and gender of children or stepchildren: ____________________________________ ___________________________________________________________________________ 11. Occupations of your adult children or stepchildren: ___________________________________________________________________________ __________________________________________________________________________ 12. What are/were your parents’ occupations? ________________________________________ ___________________________________________________________________________ 13. Do you have any difficulty reading or speaking the English language or understanding the written or spoken English language? Yes  No  14. Do you have any health problems or take any prescription medication that could affect your ability to see, listen to, and understand the testimony as given by the witnesses and to review documents and other exhibits that you may be asked to read? Yes  No  15. Do you have any physical problem that would make it difficult for you to sit for extended periods of time? Yes  No  16. What city/township and county do you presently live in? City/Township: ________________________ County: _____________________ How long have you lived there? _____________________ If you have lived in the area less than one year, list previous residences in past five years: ___________________________________________________________________________ ___________________________________________________________________________ 17. Have you, your spouse or companion, or any of your adult children ever lived in Cuyahoga County? Yes  No  If yes, briefly elaborate: __________________________________________________________________________ ___________________________________________________________________________ Case: 1:10-cr-00387-SL Doc #: 632-1 Filed: 01/17/12 3 of 11. PageID #: 12937 18. Do you and the others with whom you live, if any, rent or own your residence? Own  Rent  19. Are you currently enrolled in any class or training program either part-time or full-time? Yes  No  If yes, please explain: ___________________________________________________________________________ ___________________________________________________________________________ 20. What are your leisure time activities? ___________________________________________________________________________ ___________________________________________________________________________ 21. Please list all unions or civic, social, political, professional, and religious groups, clubs, or organizations to which you or your spouse or companion belongs: ___________________________________________________________________________ ___________________________________________________________________________ 22. Have you ever served on a jury before? Yes  No  If yes: (a) Was it  Federal  State? (Check all that apply.) (b) Was it  Criminal  Civil? (Check all that apply.) (c) Briefly explain the case(s): ___________________________________________________________________________ ___________________________________________________________________________ (d) Did you reach a verdict? Yes  No  (e) Did you serve as foreperson? Yes  No  (f) Is there anything about your prior jury service that left you disappointed or unwilling to serve again as a juror? Yes  No  If yes, please explain: _________________________________________________________ ___________________________________________________________________________ 23. Have you ever served on a grand jury? Yes  No  If yes, when and where did this occur:____________________________________________ 24. Have you or an immediate family member ever been a plaintiff in a civil lawsuit? Yes  No  If yes, please explain: _____________________________________________________________________ _____________________________________________________________________ Case: 1:10-cr-00387-SL Doc #: 632-1 Filed: 01/17/12 4 of 11. PageID #: 12938 25. Have you or an immediate family member ever been a defendant in a civil lawsuit? Yes  No  If yes, please explain: _____________________________________________________________________ _____________________________________________________________________ 26. Have you, an immediate family member or a close friend ever been arrested or charged with a crime? Yes  No  If yes, please explain: __________________________________________________________________________ __________________________________________________________________________ 27. Have you, an immediate family member or a close friend ever been a defendant in a criminal case? Yes  No  If yes, please explain: ____________________________________________________________________ ____________________________________________________________________ 28. Have you, an immediate family member or a close friend ever had any contact, relationships or dealings with the police, the legal system or the court system? Yes  No  If yes, please explain: __________________________________________________________________________ _________________________________________________________________________ 29. Have you, an immediate family member or a close friend ever been a victim of or a witness to a crime, whether that crime was reported or not? Yes  No  If yes, please explain; _________________________________________________________________________ _________________________________________________________________________ Case: 1:10-cr-00387-SL Doc #: 632-1 Filed: 01/17/12 5 of 11. PageID #: 12939 30. Have you, an immediate family member or a close friend had any dispute with the United States government, including any department or agency, or do you anticipate one in the future? Yes  No  If yes, please explain: ___________________________________________________________________________ ___________________________________________________________________________ 31. Have you or your spouse or companion ever had a tax return audited by the IRS or by a state or local taxing authority? Yes  No  32. What is your opinion of the jury system?  Favorable  Unfavorable  No Opinion 33. Have you, an immediate family member or a close friend ever campaigned for, or been elected to, or been appointed to, public office, or worked in the office of any elected or appointed public official at the federal, state or local level, or been a lobbyist? Yes  No  If yes, please explain: __________________________________________________________________________ __________________________________________________________________________ Is there anything about your experience or that of your family member or close friend that would affect your ability to be a fair and impartial juror in this case? ___________________________________________________________________________ ___________________________________________________________________________ 34. Do you or an immediate family member sit on or hold any office with any of the governing councils, boards, panels, etc., of the community or municipality in which you live? Yes  No  If yes, please explain: __________________________________________________________________________ ___________________________________________________________________________ Case: 1:10-cr-00387-SL Doc #: 632-1 Filed: 01/17/12 6 of 11. PageID #: 12940 35. Have you ever participated in a political campaign? Yes  No  If yes, list which campaign(s) and the year(s) and describe your involvement: ___________________________________________________________________________ ___________________________________________________________________________ 36. Have you ever donated to a political campaign? Yes  No  37. Have you, an immediate family member or a close friend ever been self-employed, a business owner, a corporate officer, or a member of the board of directors in any business or corporation? Yes  No  If yes, please explain: ___________________________________________________________________________ ___________________________________________________________________________ 38. Have you or an immediate family member ever been employed by a federal, state or local government agency? Yes  No  If yes, please explain:_________________________________________________________ __________________________________________________________________________ 39. Have you or an immediate family member ever had to interact with a government agency as part of your job? Yes  No  If yes, describe the type(s) of interaction:__________________________________________ ___________________________________________________________________________ 40. Have you ever been involved in negotiating contracts as part of your job? Yes  No  Case: 1:10-cr-00387-SL Doc #: 632-1 Filed: 01/17/12 7 of 11. PageID #: 12941 41. Have you ever been involved with a company or business that bid for contracts from a local, state or federal government? Yes  No  If yes, please briefly describe the nature of each contract you have been involved in bidding on:________________________________________________________________________ ___________________________________________________________________________ 42. Have you, an immediate family member or a close friend ever studied law, practiced law, or been employed by a law firm? Yes  No  If yes, please explain:_________________________________________________________ __________________________________________________________________________ 43. Have you, an immediate family member or a close friend ever applied to work, worked for or with, or volunteered with any law enforcement organization or agency (federal, state, county or local) or any private investigation firm, or served in any other capacity in the fields of corrections, the court system, criminal justice, or victim(s) assistance? Yes  No  If yes, please explain:_________________________________________________________ __________________________________________________________________________ 44. The government in this case is represented by the following members of the U.S. Attorney’s Office. Indicate by a check mark if you know or have had any contact, whether social or professional, with these attorneys or anyone in the U.S. Attorney’s Office.  Antoinette Bacon, Esq.  Ann Rowland, Esq.  Nancy Kelley, Esq.  Other attorneys or employees of the U.S. Attorney’s Office If yes to any of the above, please explain: ________________________________________ __________________________________________________________________________ Case: 1:10-cr-00387-SL Doc #: 632-1 Filed: 01/17/12 8 of 11. PageID #: 12942 45. In this case a defendant will be represented by one or more of the following attorneys or law firm. Indicate by a check mark if you know or have had any contact, whether social or professional, with any of these attorneys or the law firm.  Law Firm of William T. Whitaker Co., LPA  William T. Whitaker, Esq.  Andrea L. Whitaker, Esq.  Leif B. Christman, Esq.  David Oakley, Esq. If yes to any of the above, please explain:________________________________________ __________________________________________________________________________ 46. The judge presiding in this case is Judge Sara Lioi. Do you know or have you had any contact, whether social or professional, with her or any members of her staff? Yes  No  If yes, please explain:_________________________________________________________ __________________________________________________________________________ 47. List any organizations to which you donate money: _________________________________ __________________________________________________________________________ 48. Do you or your spouse or companion have bumper stickers on your car? Yes  No  If yes, what do they say?_______________________________________________________ __________________________________________________________________________ 49. What, if any, television programs do you watch regularly? ___________________________________________________________________________ __________________________________________________________________________ 50. What courtroom- or law-related shows do you watch?_______________________________ __________________________________________________________________________ 51. What newspapers, magazines, radio stations, or on-line information services do you regularly read or use? ________________________________________________________________ __________________________________________________________________________ 52. How often do you view, read or listen to the news?  Every day  A few times a week  Occasionally  Rarely  Never Case: 1:10-cr-00387-SL Doc #: 632-1 Filed: 01/17/12 9 of 11. PageID #: 12943 53. What websites do you regularly visit?____________________________________________ __________________________________________________________________________ 54. How often do you visit any social networking site such as Facebook, Myspace, Twitter, etc.?  Every day  A few times a week  Occasionally  Rarely  Never 55. Do you have a blog or website? Yes  No  If yes, please explain:_________________________________________________________ __________________________________________________________________________ 56. Do you regularly view or follow blogs of others? Yes  No  If yes, please indicate the blog(s) and topic(s): ___________________________________________________________________________ __________________________________________________________________________ 57. Do you visit chat rooms? Yes  No  If yes, which one(s):__________________________________________________________ __________________________________________________________________________ 58. Where do you receive most of your news and information? (Check only one)  TV  Radio  Newspapers  Internet  Conversations with others  Other 59. What are your sources of news? (Check all that apply)  WJW (Fox) or website (Channel 8)  The Plain Dealer or Cleveland.com  WKYC (NBC) or website (Channel 3)  The Akron Beacon Journal or Ohio.com  WEWS (ABC) or website (Channel 5)  Scene Magazine  WOIO (CBS) or website (Channel 19)  Wooster Daily Record  WAKR (1590)  The Canton Repository  WHLO (640)  Twitter  WKSU (89.7)  Facebook  WCPN (90.3)  Myspace  WNIR (100.1)  Friends, relatives or other people List any other sources you rely on for news: Case: 1:10-cr-00387-SL Doc #: 632-1 Filed: 01/17/12 10 of 11. PageID #: 12944 60. The evidence in this trial will include recordings of telephone conversations obtained by court-authorized wiretaps. In some of the recordings, the parties being recorded may use profanity, curse and swear. Would the use of such language prevent you from evaluating this evidence as a fair and impartial juror? Yes  No  61. Prior to receiving this questionnaire, had you read, heard or seen anything about former Cuyahoga County Commissioner James C. Dimora, or former Cuyahoga County employee Michael Gabor, or this case or the investigation, or cases involving other former public officials of Cuyahoga County, including former Cuyahoga County Auditor Frank Russo? Yes  No  Maybe  If yes, briefly describe what you have read, seen or heard about those individuals or about this case: ___________________________________________________________________________ ___________________________________________________________________________ (a) Indicate by check mark whether you heard about those individuals or this case from any of the following sources (check as many as apply):  TV  Radio  Newspaper  Magazines  Websites  Other internet source  Conversations with others  Overheard discussions  Other ____________ (b) How would you describe your knowledge of this case? (check one)  Very knowledgeable  Somewhat knowledgeable  Not very knowledgeable  No knowledge at all (c) Have you published any written comments about this case, including any comment on an online newspaper, a blog, or any social networking site? Yes  No  If yes, where were your comments published and what was the substance of what you said?