Juror Questionnaire

1. Name ___________________ 2. Age ____________________ 3. Are you ___ Male ___Female6. Where were you born? __________________________________________________ 7. In what neighborhood do you live? _______________________________________ 7a. How long have you lived in that neighborhood? _______________________ 7b. How long have you lived in Manhattan? _____________________________ 8. With whom do you live? Please list the people with whom you live and include their relationship to you, their age and their occupation:Relationship to youAgeOccupation9. If you have any children, stepchildren or grandchildren, please indicate their relationship toyou and their gender, age and school or occupation:Relationship to you(i.e. child, step, grandchild)genderageSchool/Occupation

210. If you have any sisters, brothers, stepsisters, stepbrothers, half-sisters or half-brothers, pleaseindicate their relationship to you, age and school or occupation:Relationship to you(i.e. brother, sister, half, step etc.)ageSchool/Occupation11. How far did you go in school? ___ Less than high school___High School Graduate/GED ___ Some College or tech school___College Graduate ______________ (major) ___ Some graduate education___Graduate Degree _____________ (degree)12. Are you employed? ___Yes___No12a. If yes, what is your occupation and how long have you had this job? ______________________________________________________________ 12b. If no, please list your last occupation and the dates you worked: ______________________________________________________________ ______________________________________________________________ 13. Please indicate whether you, or a member of your family, ever served in the military, what branch, what rank, and the length of service:PersonBranchRankLength of Service

314. What are your favorite newspapers, magazines, TV shows, radio programs and websites? Newspapers: ____________________________________________________________ Magazines: ____________________________________________________________ TV Shows: ____________________________________________________________ Radio Programs:____________________________________________________________ Websites: ____________________________________________________________ 15. What are your hobbies or leisure time activities? To what organizations do you belong? Hobbies: _________________________________________________________________ Leisure Time Activities:______________________________________________________ Organizations: _____________________________________________________________ 16. Do you contribute to charities, or to cultural or other non-profit organizations? ___Yes ___No17a. If Yes, to what charities, cultural or other non-profit organizations do you contribute? ___________________________________________________________________ 17. What is the largest contribution you have ever made to a charity or to a cultural or non-profit organization? ___ Less than $100 ___$100 - $499 ___$500 - $999 ___$1,000 - $9,999 ___$10,000 or more18.Do you have any particular expertise on the topic of wills and/or powers of attorney? ___Yes___No18a. If yes, please explain: ___________________________________________ _____________________________________________________________