State of Minnesota v Derek Chauvin

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27-CR-20-12040

***THIS IS A DEMONSTRATION ONLINE QUESTIONNAIRE THAT CONVERTS THE WRITTEN QUESTIONNAIRE TO AN ONLINE VERSION. THE ORIGINAL INSTRUCTIONS AND QUESTIONS ARE INCLUDED FOR AUTHENTICITY. SOME INSTRUCTIONS AND QUESTIONS WOULD BE CHANGED TO MATCH ONLINE DESIGN AND PROTOCOLS. PLEASE NOTE THAT A "PRIVATE" RESPONSE OPTION WAS ADDED TO THE CLOSED-ENDED QUESTIONS IN LIGHT OF THE ORIGINAL INSTRUCTIONS. AN ALTERNATIVE WOULD BE TO ADD A SECTION AT THE END WHERE THE JURORS IDENTIFY ANY "PRIVATE" ANSWERS BY QUESTION NUMBER. THE FOLLOW-UP QUESTIONS WERE DESIGNATED WITH AN "a" or "b" TO MINIMIZE CONFUSION (E.G., Q2a). OTHER ONLINE DESIGN FEATURES (E.G., "REQUIRED" ANSWER SETTING) HAVE BEEN DISABLED TO ALLOW A FULL VIEWING OF THE QUESTIONNAIRE.*****

District Court Use Only: ____________

27-CR-20-12040

Filed in District Court State of Minnesota 12/22/2020 12:16 PM

Hennepin County Special Juror Questionnaire

You are a potential juror in the trial of four former police officers charged in connection with the death of George Floyd. From this day forward, DO NOT read or intentionally view anything about these cases or do any investigation or research related to these cases.

The information in this questionnaire is for the judge and attorneys that will be involved in this trial and is required information. This questionnaire will be filed as a public document in the court record at the end of the trial, but until then, your name and the fact that you are a potential juror will NOT be public. For that reason, DO NOT disclose to anyone that you are a potential juror in this case.

***𝐏𝐋𝐄𝐀𝐒𝐄 𝐔𝐒𝐄 𝐁𝐋𝐀𝐂𝐊 𝐏𝐄𝐍 𝐎𝐍𝐋𝐘 𝐀𝐍𝐃 𝐃𝐎 𝐍𝐎𝐓 𝐖𝐑𝐈𝐓𝐄 𝐎𝐍 𝐓𝐇𝐄 𝐁𝐀𝐂𝐊 𝐎𝐅 𝐀𝐍𝐘 𝐏𝐀𝐆𝐄.

***𝐘𝐎𝐔 𝐌𝐔𝐒𝐓 𝐑𝐄𝐓𝐔𝐑𝐍 𝐓𝐇𝐈𝐒 𝐒𝐇𝐄𝐄𝐓 𝐀𝐍𝐃 𝐓𝐇𝐄 𝐂𝐎𝐌𝐏𝐋𝐄𝐓𝐄𝐃 𝐐𝐔𝐄𝐒𝐓𝐈𝐎𝐍𝐍𝐀𝐈𝐑𝐄 𝐁𝐘 𝐉𝐀𝐍𝐔𝐀𝐑𝐘 𝟐, 𝟐𝟎𝟐𝟏.

Your Juror Identification Number (9 digits):

Your Full Name:

Your Phone Numbers (cell, work and home):

𝐘𝐨𝐮 𝐬𝐡𝐨𝐮𝐥𝐝 𝐛𝐫𝐢𝐧𝐠 𝐚 𝐩𝐢𝐜𝐭𝐮𝐫𝐞 𝐈𝐃 𝐰𝐢𝐭𝐡 𝐲𝐨𝐮 𝐰𝐡𝐞𝐧 𝐲𝐨𝐮 𝐜𝐨𝐦𝐞 𝐭𝐨 𝐜𝐨𝐮𝐫𝐭 𝐟𝐨𝐫 𝐭𝐡𝐞 𝐟𝐢𝐫𝐬𝐭 𝐭𝐢𝐦𝐞.

Your contact information will remain confidential and available only to District Court staff. The parties and attorneys for the parties will have access to your name, but will refer to you in the courtroom by a random number to be assigned by District Court. Contact the District Court Jury Office at (612) 348-3158 if you have any questions.

By returning the completed questionnaire, you are declaring under penalty of perjury that everything you have stated in this document is true and correct.

I understand and do so declare.

Sign Here:

Signed on this date in County.

By marking the "affirm" box below, you are declaring under penalty of perjury that everything you have stated in this document is true and correct. I understand and do so declare.

STATE OF MINNESOTA DISTRICT COURT

COUNTY OF HENNEPIN FOURTH JUDICIAL DISTRICT

State of Minnesota,

Plaintiff,

𝐒𝐏𝐄𝐂𝐈𝐀𝐋 𝐉𝐔𝐑𝐎𝐑 𝐐𝐔𝐄𝐒𝐓𝐈𝐎𝐍𝐍𝐀𝐈𝐑𝐄

vs.

Derek Michael Chauvin, Dist Ct. File 27-CR-20-12646
Tou Thao, Dist Ct. File 27-CR-20-12949
Thomas Kiernan Lane, Dist Ct. File 27-CR-20-12951
J. Alexander Kueng, Dist Ct. File 27-CR-20-12953

Defendants.

Please answer all of the questions as completely and honestly as you can. You must answer all questions, but you may answer “PRIVATE” if disclosure of some of your past experiences would be particularly sensitive, traumatic, or embarrassing and the judge will address those questions in court as privately as possible. As you answer these questions, please keep in mind that there are no “right” or “wrong” answers, but you are answering these questions under oath and YOU WILL BE REQUIRED TO VERIFY UNDER OATH THAT YOUR ANSWERS ARE TRUE WHEN YOU COME TO COURT FOR THE FIRST TIME.

***Extra blank pages are attached <Extra space is provided at the end of this online questionnaire> if you need additional room for answers***

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