Case Document 122 Filed 07/11/18 Page 3 of 13 Page D# 2005 JURY QUESTIONNAIRE Instructions for 1m Questionnaire This questionnaire is designed to obtain information about your background as it may relate to your service as a juror in this case. The questionnaire?s use is intended to shorten the jury selection process. The purpose of these questions is to determine whether prospective jurors can impartially decide this case based solely on the evidence presented at trial and the instructions on the law given by the judge. The information you provide in response to this questionnaire will be kept con?dential. Please write your assigned juror number at the top of each page. Respond to each and every question. Your candor and honesty is necessary and your cooperation is of vital importance. You are sworn to give true and complete answers and those answers will be available only to the Court and the parties in this case. You are instructed not to discuss this case or the questionnaire with anyone, including your family and fellow jurors. You are further instructed not to conduct any research of any kind about this case or the participants in this case, nor are you permitted to obtain information about this case or its participants from any outside sources of any kind whatsoever. Please ?ll out the entire questionnaire. Do not leave any questions blank. If a question does not apply to you in any way, write rather than leaving the form blank. You will be asked further questions by the judge in the courtroom. PLEASE PRINT LEGIBLY Case Document 122 Filed 07/11/18 Page 4 of 13 Page D# 2006 Juror Number: 1. Name: 2. Sex: 3. Date of Birth: 4. Place of Birth: 5. Address: 6. Are you employed? Yes No A. If employed, what is your current occupation job title? B. Name of employer: C. How long have you been employed at your current job? 7. Please describe other responsibilities that you have which may include childcare, eldercare, school, etc.) 8. If you are retired or between jobs, what type of work had you been doing? 9. Is your spouse or companion who lives with you employed? And if so, by whom? Yes No Spouse?s Employer: Case Document 122 Filed 07/11/18 Page 5 of 13 Page D# 2007 Juror Number: 10. Describe the highest level of education you have completed. 11. Are you presently a student? And is so, where? 12. Do you have any dif?culty speaking, understanding, reading or writing the English language? Yes No A. If yes, please explain the degree of dif?culty: 13. Have you, or has any member of your family or close friend or relative, ever been accused of, arrested for, or charged with a crime? Yes No A. If yes, please state who was accused of, arrested, or charged with a crime and their relationship to you and also provide a brief description of the alleged crime(s): Case Document 122 Filed 07/11/18 Page 6 of 13 Page D# 2008 Juror Number: B. If yes, do you feel that you, your family member, close ?iend, or relative were/was treated fairly by the criminal justice system? 14. Have you, or has any member of your family or close friend or relative, ever been audited by the Internal Revenue Service? Yes No A. If yes, do you feel that you, your family member, close friend, or relative were/was treated fairly by the Internal Revenue Service? 15. Apart from jury service, have you ever been involved in any legal proceeding, in any capacity, for example as a plaintiff, defendant, victim, lawyer, witness, or expert? Yes No A. If yes, please state when and explain why you appeared in court: B. If yes, did the legal process in that instance operate fairly in your opinion? Case Document 122 Filed 07/11/18 Page 7 of 13 Page D# 2009 Juror Number: 16. Have you ever served as a juror at a trial in a federal, state, or local court prior to today? Yes No A. If yes, please circle what best describes the case on which you served as a juror: Criminal Case OR Civil Case Jury Reached a Verdict OR Jury Did Not Reach a Verdict If you served as a juror on multiple cases you can provide descriptions of those additional cases below: 17. Have you ever served as a juror on a grand jury in federal or state court? Yes No A. If yes, when and where: B. If yes, was the grand jury on which you served able to reach agreement on the issuance of true bills? Yes No 18. Have you, or any members of your family, ever been employed by any law enforcement agency, such as: a police department, sherist department, constable?s of?ce, the Federal Bureau of Investigation (FBI), the Drug Enforcement Administration (DEA), the Bureau of Alcohol Tobacco and Firearms (ATF), the US. Marshal?s Service, the US. Park Police, a United States Attomey?s Of?ce, the United States Department of Justice, a District or State?s Attomey?s Of?ce, a probation or parole of?ce, the Bureau of Prisons, or any other state, local, or federal law enforcement agency or private security force? Yes No Case Document 122 Filed 07/11/18 Page 8 of 13 Page D# 2010 Juror Number: A. If yes, for each person (yourself or family member) please indicate the law enforcement office or agency, the period of time employed, if known, and a general description of the job duties: B. Would the law enforcement employment that you described question prevent or hinder you in any way from rendering a fair and impartial verdict in this case based solely on the evidence presented and the Court?s instructions on the law? 19. Have you, or any members of your family, ever been employed by the Internal Revenue Service? Yes No A. If yes, for each person (yourself or family member) please indicate the period of time employed, if known, and a general description of the job duties: B. If yes, would the employment that you described in the previous question prevent or hinder you in any way from rendering a fair and impartial verdict in this case based solely on the evidence presented and the Court?s instructions on the law? Case Document 122 Filed 07/11/18 Page 9 of 13 Page D# 2011 Juror Number: 20. Have you, or any members of your immediate family, ever been employed as an auditor, mortgage of?cer, tax preparer, or accountant? Yes No A. If yes, for each person (yourself or family member) please indicate the period of time employed, if known, and a general description of the job duties: B. If yes, would the employment that you described when answering question prevent or hinder you in any way from rendering a fair and impartial verdict in this case based solely on the evidence presented and the Court?s instructions on the law? 21. Have you, or any member of your immediate family, ever worked as an employee of a bank or ?nancial institution? Yes No A. If yes, for each person (yourself or family member) please indicate the period of time employed, if known, and a general description of the job duties: Case Document 122 Filed 07/11/18 Page 10 of 13 PagelD# 2012 Juror Number: B. If yes, would the employment that you described when answering question 21 (A) prevent or hinder you in any way from rendering a fair and impartial verdict in this case based solely on the evidence presented and the Court?s instructions on the law? 22. Have you, or any member of your immediate family, ever worked in the legal profession, either as a lawyer, paralegal, or in a law of?ce, including a prosecutor?s or public defender?s of?ce? Yes No A. If yes, please explain: B. If yes, would the legal employment that you described when answering question prevent or hinder you in any way from rendering a fair and impartial verdict in this case solely on the evidence presented and the Court?s instructions on the law: 23. Have you ever applied to ?nance or re-?nance real property? Yes No Case Document 122 Filed 07/11/18 Page 11 of 13 PagelD# 2013 Juror Number: A. Is there anything about the process of applying for ?nancing or re-?nancing that you found remarkable? If so, please describe: 24. This case has received signi?cant publicity in the media. Have you seen, read, or heard anything at all about this case in any form of media, including newspaper, television, radio, or intemet? Yes No A. If yes, please describe what you have seen, read, or heard, (ii) the source of that information, and when that occurred: B. If yes, has the news coverage or other information you have seen, read, or heard about this case caused you to form an opinion about the defendant or defendant?s guilt or innocence in this case? Yes No C. If yes, please explain: Case Document 122 Filed 07/11/18 Page 12 of 13 PagelD# 2014 Juror Number: D. Would you be able to put to one side everything you have seen, read, heard or know about this case and not consider that information at all in your consideration of the case and instead decide this case fairly and impartially based solely on the evidence presented and the Court?s instructions on the law? 25. The government may produce evidence in this case that the defendant had business ties to foreign governments and leaders speci?cally the Ukraine and the Ukrainian President. Having ties to a foreign government or leader is, of course, in and of itself, not a crime. But knowing this information would you nonetheless ?nd it dif?cult to decide the case fairly and impartially based solely on the evidence presented and the Court?s instructions on the law? Yes No A. If yes, please explain: 26. Do you suffer from any physical or mental condition(s) that would affect your ability to pay close and careful attention to the evidence and to render an impartial verdict? Yes No A. If yes, please explain: 27. This trial may last for approximately three weeks. In this respect, you should know that it is unlawful for an employer to discharge, threaten to discharge, intimidate, or coerce any employee because of the employee?s jury service. Given this, is there any truly exigent circumstance that would preclude you from serving on this jury? A truly exigent 10 Case Document 122 Filed 07/11/18 Page 13 of 13 PagelD# 2015 Juror Number: circumstance includes, but not limited to, having prepaid travel arrangements or serving as the sole caregiver to a child, elderly, or disabled person? (Note: General concerns about missing work or social obligations are not justi?cations for being excused from jury service.) Yes No A. If yes, please explain: AF FIRMATION: I, hereby 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. I have answered all of the above questions myself. Executed in the Eastern District of Virginia, on this day of 2018. Signature 11