NAME:____________________________
JUROR QUESTIONNAIRE
Thank you for coming to court as a potential juror. The questions on this form are designed to help the court and the
lawyers learn something about your background and your views on issues that may be related to this case. The questions
are not asked to invade your privacy, but to make sure that you can be a fair and impartial juror. This questionnaire will
remain confidential and will only be shared with the lawyers, the judge, and court staff.
You should answer the questions carefully and completely. Please do not leave any questions blank. If a question does
not apply to you, simply write N/A (for Not Applicable) in the space for the answer. If there is no response to a question,
we will assume that you mistakenly skipped it and may ask you about it in court.
Please DO NOT write on the back of any page. If you need more room, continue at the bottom or side of the page or
on a blank page.
You may be asked follow-up questions later to clarify your answers. If there are questions that you would feel more
comfortable answering in private, simply write "private" in the space provided for your answer and circle the question
number. Any follow-up questions on that topic will be held out of the presence of the other jurors.
If you have trouble reading, understanding, or filling out this form, please let the court clerk know.
PLEASE REMEMBER THAT YOU ARE ANSWERING THESE QUESTIONS UNDER PENALTY OF
PERJURY. YOUR ANSWERS MUST BE TRUE AND COMPLETE.
1. City/Town where you live: _____________________________
2. What is your highest level of education and what year did you graduate? _______________________________
3. What is your occupation (or what was your latest occupation if you are retired unemployed, or disabled)?
__________________________________________________________________________________________
__________________________________________________________________________________________
4. Have you ever owned your own business? Yes _____ No _____
If Yes, please describe the type of business, the number of employees and the length of time the business is or
was owned:
__________________________________________________________________________________________
__________________________________________________________________________________________
5. Have you visited any of the following establishments:
____ Blue Moose Bar & Grill (Prairie Village, KS) ____ Barley’s Brewhaus (Shawnee, KS)
____ Blue Moose Bar & Grill (Lenexa, KS) ____ Moose Truck Food Truck
____ Stroud’s (Overland Park, KS) ____ O’Dowd’s Gastrobar (Kansas City, MO)
____ The View at Briarcliff (Kansas City, MO) ____ Hy-Vee Arena (Kansas City, MO)
____ Blue Moose Bar & Grill (Kansas City, MO)
If Yes, when was the last time you visited each establishment you identified? __________________________
________________________________________________________________________________________
Case 4:20-cv-00437-SRB Document 188-1 Filed 10/12/21 Page 1 of 4
Also, have you had any catering done for you by Hopps Catering of Overland Park, Kansas? Yes____ No ____
If Yes, when did that happen? ________________________________________________________________
6. Have you or a family member ever worked for the Cincinnati Insurance Company or any affiliated companies?
Yes ___ No ___
If Yes, please describe the nature of the position: ___________________________________
_________________________________________________________________________________________
7. Have you or a loved one ever worked for any insurance company? Yes ____ No ____
If Yes, please describe the nature of the position:__________________________________________________
_________________________________________________________________________________________
8. Have you ever sued someone or been sued by someone? Yes ____ No ____
If Yes, please describe the type of case, the location of the suit, and the outcome: ________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
9. Are you presently being treated for a medical condition that could affect your ability to sit as a juror?
Yes ____ No ____
If Yes, please describe: ______________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
10. Have you or a family member tested positive for the SARS-CoV-2 (COVID-19) virus? Yes ____ No ____
11. Have you been vaccinated against the SARS-CoV-2 (COVID-19) virus? Yes ____ No____
12. Do you believe people should wear masks while indoors to protect against the transmission of SARS-CoV-2
(COVID-19)? Yes ____ No ____
13. How much do you disagree or agree with the following opinions? Circle a number between 1 and 4.
Strongly Agree Disagree Strongly
Agree Disagree
There are too many lawsuits in our society. 1 2 3 4
Lawsuits are costing us all too much. 1 2 3 4
People in our society today are too ready to sue. 1 2 3 4
Corporations can never be trusted. 1 2 3 4
Jury awards are too high. 1 2 3 4
2
Case 4:20-cv-00437-SRB Document 188-1 Filed 10/12/21 Page 2 of 4
14. What television news do you regularly watch? (Circle as many as apply.)
ABC network BBC CBS Network CNN Fox Network MSNBC NBC Network
OANN None Others (list): _____________________________________________________________
15. What radio/internet talk shows/podcasts do you listen to? ___________________________________________
_________________________________________________________________________________________
16. If you or a family member suffered loss because of the fault of another, would you sue?
Yes _____ No _____ It depends _____
Please explain your answer:
_____________________________________________________________________________________
_____________________________________________________________________________________
17. Have you or a family member ever made a claim against an insurance company that was resolved without the
need to file a lawsuit?
Yes _____ No _____
If Yes, please explain: ______________________________________________________
__________________________________________________________________________________________
18. Have you or a family member ever worked in a restaurant? Yes___ No___
If Yes, please identify the restaurant and the position or positions you held there: ________________________
_________________________________________________________________________________________
19. Have you or a family member ever worked for KC Hopps or any of its affiliated bars or restaurants?
Yes ___ No ___
If Yes, please identify the bar or restaurant, years of employment and positions held: _______
__________________________________________________________________________________________
20. We think this trial will last one week. Is there any reason why you could not attend a one week trial?
If so, why?_____________________________________________________________________________
21. After completing this questionnaire, do you know of any reason at all (for example, religious, emotional,
political, or personal) that would make it difficult for you to be a fair and impartial juror in this case?
Yes _____ No _____
If yes, please explain: _______________________________________________________________________
_________________________________________________________________________________________
3
Case 4:20-cv-00437-SRB Document 188-1 Filed 10/12/21 Page 3 of 4
I declare under penalty of perjury, that the previous answers are true and correct to the best of my knowledge.
Executed in the County of Jackson, Missouri on October ___, 2021.
_____________________________________
SIGNATURE
4
Case 4:20-cv-00437-SRB Document 188-1 Filed 10/12/21 Page 4 of 4
Agreed Juror Questionnaire
The questionnaire below has been approved by the Court and will be filled out by
each prospective juror. To select jurors, the Court and the parties require certain
information. This form is designed to save time and assist the Court and the parties
to move forward as quickly as possible. Please answer the questions below honestly
and completely. This information will be kept confidential and will not be used for
any other purpose except to select a jury.
Please print all answers legibly. If you need extra space to write in answers, please
use the blank space on the final page. Please DO NOT write on the back of any page.
1. Name: ________________________________ Juror #: _____________
2. Age: _________
3. What city and county do you live in? ________________________________
4. How would you describe the area where you live?
___ Urban ___Suburban ___Rural
5. What is the highest level of education you completed?
Middle school/Some high school Junior College/Associates Degree
High school graduate 4- Yr. College Graduate
Technical / Trade School Graduate Post-graduate work
Some college Post-Graduate Degree
If you attended school past high school/GED, what was your area(s) of study?
_____________________________________________________________
6. Please list all groups or organizations in which you participate or are a
member (e.g., political or civic organizations, church or church groups,
professional organizations, volunteer activities, social or charitable groups,
neighborhood groups, or self-help groups).
_________________________________________________________________
_________________________________________________________________
7. Have you ever held any leadership positions in any of these organizations?
___Yes ___No
8. What is your current employment status?
Working full-time Unemployed, looking for work time
Full-time student Working part-time
Unemployed, not looking Disabled
Homemaker Retired (when:_______________)
9. If currently employed: (If retired, unemployed, homemaker, OR a full-time
student, please answer regarding your last job)
What is your current or most recent occupation:_____________________________
By whom are/were you employed:_______________________________________
For how long:____________
10. Please list your previous four occupations and indicate how many years you
worked in each.
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
11. Have you ever had the authority to hire, fire, discipline, and/or supervise
others at work?
___Yes ___No
If YES, what is the largest number of people you supervised at one time? _____
12. What is your marital status? (If divorced, please check divorced, not single.)
2
Single and never married
Currently married
Living with significant other
Divorced/separated
Single, but married in the past
Widowed
13. What is your spouse/partner’s occupation and employer?
(If not applicable, please write “N/A”)
_____________________________________________________________
14. Do you have any children or stepchildren?
___Yes ___No
If YES please complete the following for each child or stepchild:
Age: Level of Education: Occupation or Grade:
_____ ________________ _______________________
_____ ________________ _______________________
_____ ________________ _______________________
_____ ________________ _______________________
_____ ________________ _______________________
15. Have you ever worked for a company that used automated technologies for
processing or manufacturing?
Yes, and I learned something about these technologies in the course of
my work
Yes, but my job there had nothing to do with these technologies
No
3
16. Have you ever worked with any sort of food processing or slicing
equipment?
___Yes ___No
If YES, what were the names of the equipment manufacturers and models?
(If you don’t remember, please write “I don’t remember.”)
_____________________________________________________________
17. Do you have hobbies, and if so, what are they?
_____________________________________________________________
18. Have you, a family member, or a close friend ever invented or created
anything, applied for or been named as an inventor on a patent, or owned a
copyright, trademark, or other form of intellectual property?
___ Yes ___ No
If YES please explain:
_____________________________________________________________
_____________________________________________________________
19. Have you or someone close to you ever been in a dispute or litigation over
intellectual property (such as a patent, copyright, or an idea)?
___ Yes ___ No
If YES please explain:
_____________________________________________________________
_____________________________________________________________
4
20. Have you or an employer ever owned patents, copyrights, or trademarks?
___ Yes ___ No ___ Unsure
If YES please explain:
_____________________________________________________________
_____________________________________________________________
21. Do you have any positive or negative opinions of the US Patent Office?
___ Yes ___ No
If YES please explain:
_____________________________________________________________
_____________________________________________________________
22. Please indicate what, if any, prior juror experience you have had.
Civil or Nature of case When/Where? Foreperson Did jury reach
Criminal (e.g., robbery or (Yes/No) a verdict?
personal injury) (Mark yes or
no)
1
2
3
4
5
23. Have you, an immediate family member, or a close friend ever filed, been a witness in,
or been sued in a lawsuit? ___ Yes ___ No
If YES please explain:
_____________________________________________________________
_____________________________________________________________
24. Do you, a family member, or close friend have any relationship with,
affiliation with, personal knowledge of, or employment experience with any
of the following law firms, lawyers, companies, or individuals listed below,
either now or in the past?
Law Firms Yes No
Husch Blackwell LLP
Willkie Farr & Gallagher
LLP
Levy Craig Law Firm
Sterne Kessler Goldstein &
Fox PLLC
Companies Yes No
Provisur Technologies, Inc.
Formax, Inc.
Weber, Inc.
Weber Maschinenbau
6
GMBH Breidenbach
Weber Maschinenbau
GMBH Neubrandenburg
Textor, Inc.
Textor Maschinenbau
GMBH
Other Individuals Yes No
Albrecht, Terrense
Bialey, Jurgen
Blocher, Harmut
Cissell, Gregg
Cohen, Mel
Dahlman, Richard
Danak, Rahul
Davis, Julie L.
Duesterhaus, Kevin
Goodin, Rich
Green, Jason
Hormel, Caudia
Howard, William
7
Jackowski, Nicholas
Koelewyn, Rudy
Kucklick, Frederick C.
Kurfess, Thomas R.
Leistner, Matthias
Lindee, Scott
Lowden, Mark
McCarroll, Jarrod
Miera, Jason
Nichau, Marco
Nielsen, Viggo
Radcliffe, Heather
Reinholtz, Charles
Rother, Ingo
Sandberg, Brian
Schaub, Joachim
Schmeiser, Jorg
Scriven, Scott
Stratenwerth, Gerd
Stroner, Russel
Thomas, Vincent
8
Valerdi, Ricardo
Vorst, Keith
Weber, Tobias
White, John
Wight, Ernest William
Wolcott, Tom
Zecher, Steffen
25. Do you have any opinions, positive or negative, of any of the law firms,
companies, or individuals listed above?
___ Yes ___ No
If YES please explain:
_____________________________________________________________
26. Do you have any education, training, or experience in the following areas?
a. The law or court system ___ Yes ___ No
b. Engineering ___ Yes ___ No
c. Food processing ___ Yes ___ No
d. Accounting ___ Yes ___ No
e. Computer science ___ Yes ___ No
f. Mechanics ___ Yes ___ No
g. Carpentry ___ Yes ___ No
h. Farming ___ Yes ___ No
If YES please explain:
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
9
27. Provisur Technologies, Inc. is based in Chicago, and the Weber and Textor
companies are based in Kansas City, MO, and Germany. Is there anything
about the fact that the companies are based in Chicago, Kansas City, MO,
and Germany that would cause you to favor one or some over the others?
___ Yes ___ No
If YES please explain:
_____________________________________________________________
_____________________________________________________________
28. Do you have any feelings toward large companies or corporations?
___ Yes ___ No
If YES please explain:
_____________________________________________________________
_____________________________________________________________
29. Do you have any feelings about senior corporate executives?
___ Yes ___ No
If YES please explain:
_____________________________________________________________
_____________________________________________________________
30. Do you have any philosophical, moral, ethical, or religious beliefs that
would cause you to have difficulty serving as a juror?
___ Yes ___ No
If YES please explain:
10
_____________________________________________________________
_____________________________________________________________
31. Is there any matter that has not been covered by this questionnaire
concerning any subject that you feel you should mention at this time that
might affect your ability to serve as a juror in this case?
___ Yes ___ No
If YES please explain:
_____________________________________________________________
_____________________________________________________________
11
ADDITIONAL AREA FOR EXPLANATION OF ANSWERS
12
13
JUROR QUESTIONNAIRE
Juror Name: Juror Number:
Please read these instructions carefully before you fill out the questionnaire.
This questionnaire is part of the jury selection process. Your answers will be used by the judge
and attorneys to help select a qualified jury. Please take as much time as you need to complete
this questionnaire.
It is extremely important that you answer all of the questions yourself—honestly and completely.
There are no “right” or “wrong” answers. All answers are given under penalty of perjury. If you
have trouble understanding or filling out this questionnaire, please let the court clerk know.
Some of your answers may require follow-up questions in open court by the judge or by the
attorneys. You may find some questions to be sensitive and you may prefer not to discuss your
answers in open court. If you find any question(s) sensitive, please do not answer the question(s)
and simply write “PRIVATE” in the space provided for the answer.
Please do not write on the back of any page. If you need additional space for your answers, use
the blank space provided on the last page of the questionnaire.
From this moment forward, until you are dismissed as a juror in this matter, you are
instructed by the Court not to discuss anything about this case with anyone, even your
spouse or significant other. You are instructed not to research any news or information
about this case or anything related to it, or communicate anything about this case, by any
means, including the internet, social media, radio, newspapers, discussions with others, or
in any other manner.
Thank you for your jury service,
Judge Stephen R. Bough
1
SUPPLEMENTAL JUROR QUESTIONNAIRE JUROR #
Please Print Your Name:
1. Age: 2. Gender: 3. Race/Ethnicity:
4. What county and city or town do you reside in?
5. Do you currently Rent or Own your home or Live with others and do not pay rent
6. What is the highest level of education you have completed, and what degrees/diplomas have you earned?
7. If you attended school past high school, what were your main areas of study?
8. Are you: (please check all that apply)
Employed Full Time Employed Part Time Homemaker Disabled
Retired for years Working more than one job Full Time Student Part Time Student
Unemployed (looking for work) Unemployed (not looking for work)
9. Please indicate your current occupation, job duties, and employer. (If retired, indicate prior job.)
10. Please indicate what other types of jobs you have had during the last 10 years:
11. Have you ever worked in a job where part or all of your pay was based on commission? YES NO
If YES, please describe:
12. What do you do in your spare time?
2
13. Have you or someone close to you ever owned a business? YES NO
If YES, please identify the person and describe the business, including years of operation.
14. What is your current marital status?
Single (never married) Married Living with partner (not married) Widowed Divorced Separated
If you are married or have a significant other, please list that person’s current occupation and employer, and
highest level of education:
15. What is the major source of news for you?
16. How much time do you spend on social media sites (such as Facebook, Instagram, Snapchat, Twitter/X,
TikTok, etc.)? I do not use any social media sites I do not use them daily Less than 1 hour per day
1-3 hours per day More than 3 hours per day
17. Have you ever worked or trained in the field of real estate, such as working as a real estate agent or broker,
or for a real estate agency or company? YES NO
If YES, please explain the type of real estate work, the names of any real estate company involved, and when,
and where you worked in the area of real estate:
18. Do you have a close friend or family member who has ever worked or trained in the field of real estate, such
as working as a real estate agent or broker, or for a real estate agency or company? YES NO
If YES, please explain your relationship to the person, and the type of real estate work, the names of any real
estate company involved, and when, and where they worked in the area of real estate:
19. Have you, or a close friend or family member, ever been a member of the National Association of
REALTORS® (NAR)? YES - Self YES – Close Friend or Family Member NO
20. Have you ever had a positive or negative experience with any trade association? YES NO
If YES, please explain and include the name the trade association:
3
21. Do you have a strong opinion about trade associations in general or about a specific trade association?
YES, about trade associations in general YES, about a specific trade association NO
If YES, please explain.
22. Have you ever sold a home? YES NO If YES, please answer the following:
a) Year(s) you sold a home or homes: b) City and State
c) Did you use a real estate agent to list or sell your home? YES NO
If YES, please indicate name of agent and the name of agency or broker:
If YES, please describe your positive or negative experiences with the agent:
d) Was the buyer of your home represented by a real estate agent ? YES NO UNSURE
e) Did you ever sell a home without a real estate agent such as “for sale by owner”? YES NO
Explain why or why not:
23. Have you ever bought a home? YES NO If YES, please answer the following:
a) Year(s) you bought a home or homes: b) City and State
c) Did you use a real estate agent to purchase a new home? YES NO
If YES, please indicate name of agent and the name of agency or broker:
If YES, please describe your positive or negative experiences with the agent:
d)Did your real estate agent: Find the home Negotiate the price Facilitate inspections, closing, paperwork
Other:
e) Did you ever buy a home without the use of a real estate agent?
YES NO Explain why or why not:
4
24. Have you ever owned a house, a building or other real estate property in a foreign country? (check all that
apply) YES, a house YES, a building YES, other real estate property
NO, but I have lived in a foreign country NO, but I have traveled to foreign countries
NO, and I have never been a foreign country
If YES to any of the above which foreign country/countries?
25. What are your opinions about class action lawsuits? Unfavorable Neutral Favorable
Explain:
26. Have you ever been involved in a court proceeding? YES NO If YES, please describe:
a) Were you satisfied with the outcome? YES NO No outcome
b) Is there anything about that experience that would prevent you from being fair in this case? YES NO
27. Have you ever had any prior jury service (federal or state or grand jury)? YES NO If YES:
a) How many times were for civil cases? #_______ How many times were for criminal cases? #_______
b) What were the cases about?
c) Have you ever been the foreperson? YES, # of times:______ NO
d) Did the jury reach a verdict in every case? YES NO
e) Is there anything about your prior jury experience that would prevent you from being fair in this case?
YES NO
Once a jury is selected, this trial is expected to begin on October 16, 2023, and last approximately 3
weeks. Court sessions will last from approximately 8:30 am until 5:00 pm each day, with regular breaks
approximately every 90 minutes, and a 60 minute break for lunch.
28. Do you wish to apply to the Court to be excused on the grounds that jury service in this case would be a
serious hardship to you? YES NO If YES, please explain:
5
29. Does your employer pay you for time missed as a result of jury service? YES NO UNSURE*
*If you are unsure, please find out before you return to court for jury selection questioning.
30. Do you have hearing difficulties not corrected by a hearing aid? YES NO
31. Do you have trouble seeing even with glasses or contacts? YES NO
KNOWLEDGE OF CASE
This is an antitrust case. It is brought by the plaintiffs on behalf of certain individuals who sold residential
property in the Kansas City, St. Louis, Springfield, and Columbia areas.
The five defendants are the National Association of REALTORS®, which is a real estate industry trade
association, and the following Corporate Defendants: Keller Williams Realty, Inc.; and HomeServices of
America, Inc., and its subsidiaries BHH Affiliates, LLC, and HSF Affiliates, LLC.
32. From news media, conversations with others, or any other source, have you read, seen, or heard anything
about this case or similar cases involving the real estate industry? YES NO
If YES, please describe what you have read, seen, or heard:
33. What sources have provided you with any information about this case?
34. Have you ever had a personal or professional relationship with any of the following, who are class
representatives involved in this case? (check all that apply)
Rhonda Burnett Jerod Briet Jeremy Keel Hollee Ellis Francis Harvey
If YES to any of the above, please indicate how you know them and your relationship to them:
6
35. Have you ever had a personal, business, or professional relationship with any of the following companies
or organizations: (check all that apply)
National Association of Realtors (NAR) Keller Williams Realty, Inc.
HomeServices of America, Inc. BHH Affiliates, LLC HSF Affiliates, LLC
Anywhere Real Estate, Inc. (formerly Realogy Holdings Corporation) RE/MAX, LLC
If you checked any of the above, please answer the following:
a) Have you had any especially positive or negative experience(s) with any of them? YES NO
If YES, which one(s)?
b) Have you recently heard or read anything about any of them? YES NO
If YES which one(s), what have you heard or read, and what is the source of your information?
c) Do you have an opinion or feeling about any of them? YES NO
If YES, which one(s) and what is your opinion or feeling?
Please review the list of names and organizations on the following pages and answer this final question:
36. Have you ever had a personal, business, or professional relationship with any of the named individuals,
companies, or organizations? YES NO UNSURE
If YES, or UNSURE, please indicate in the space below who you know, or may know, and how you are or may
be familiar with them and the nature of your relationship.
With my signature below, I solemnly swear or affirm that all answers herein are true,
correct and complete.
Signature: Date:
7
Please review the following list and circle any of the individuals, companies or organizations
named with which you have ever had a personal, business, or professional relationship, and
then answer the final question on the previous page. Thank you!
Plaintiff’s Counsel
Law firms
Ketchmark & McCreight, P.C. Williams, Dirks & Dameron, LLC
Boulware Law, LLC
Attorneys
Michael Ketchmark Scott McCreight
Ben Fadler Brandon Boulware
Michael Williams Eric Dirks
Matt Dameron Jeremy Suhr
Defendants’ Counsel
Law Firms
MacGill, P.C. Lathrop GPM, LLP
Foley & Lardner, LLP Holland & Knight
Brown & James, PC Cooley LLP
ArentFox Schiff, LLP Stinson, LLP
Attorneys
Robert D. MacGill Scott E. Murray
Matthew T. Ciulla Patrick J. Sanders
Jay N. Varon Jennifer M. Keas
Jean Paul Bradshaw, II Brian C. Fries
Timothy Ray David C. Kully
Anna P. Hayes Jennifer Lada
Dina W. McKenney Martin G. Durkin, Jr.
William F. Farley David R. Buchanan
Taylor L. Connolly Ethan Glass
Samantha Strauss Georgina Inglis
Beatriz Mejia Sarah Topol
Anne Bigler Deepti Bansal
Elizbeth Wright Jack R. Bierig
Jacob K. Danzinger John S. Purcell
Molly Wiltshire Robert J. Wierenga
Suzanne L. Wahl Charles W. Hatfield
Alexander C. Barrett Barack Echols
8
APPENDIX A
Century 21 Real Estate, LLC Armstrong Teasdale, LLP
Sotheby’s International Realty Horn Aylward & Bandy, LLC
Coldwell Banker Real Estate, LLC Karrie Clinkinbeard
Corcoran Group Megan J. Ochs
ERA Real Estate Danne W. Webb
ReeceNichols Andrea S. McMurtry
Better Homes And Gardens Real Scott Burnett
Estate, LLC
Ryan Hendrickson Scott Trupiano
Roger Alford Nick Bailey
Gino Blefari Sarah Butler
Karri Callahan Brian Cannan
Jon Coile Jen Davis
Michelle Figgs Mike Frazier
Rene Galicia Rodney Gansho
Kevin Goffstein Bob Goldberg
Ryan Gorman Gary Keller
Ashley Kelm Darrell King
Marc King David Liniger
Meredith Maples Sharon Millett
Cliff Niersbach Linda O’Connor
Jay Papasan Ron Peltier
John Peyton Todd Reynolds
Craig Schulman Dana Strandmo
Stefan Swanepoel Cary Sylvester
Rasalie Warner Krista Wilson
Lawrence Wu Sarah Young
9
ADDITIONAL COMMENTS
(Please mark your responses to reflect the question number you are responding to. Thank you!)
10
JUROR QUESTIONNAIRE
The questionnaire below has been approved by the Court and will be filled out by
each prospective juror. To select jurors, the Court and the parties require certain
information. This form is designed to save time and assist the Court and the parties
to move forward as quickly as possible. Please answer the questions below honestly
and completely. This information will be kept confidential and will not be used for
any other purpose except to select a jury. Please print all answers legibly. If you
need extra space to write in answers, please use the blank space on the final page.
Please DO NOT write on the back of any page.
1. Name:
_____________________________________ Juror #:__________________
2. Age: ____________ Gender: _____________ Race:_______________
3. What city and county do you live in? __________________________________
4. How would you describe the area where you live?
Urban Suburban Rural
5. What is the highest level of education you completed?
Middle school / Some high school Some college
High school graduate / GED Four-year college graduate
Junior college /Associates degree Some college
Technical / Trade school graduate Post-graduate degree
6. If you attended school past high school / GED, what was your area(s) of study?
________________________________________________________________
________________________________________________________________
________________________________________________________________
7. Please list all groups or organizations in which you participate or are a member
(e.g., political or civic organizations, church or church groups, professional
organizations, volunteer activities, social or charitable groups, neighborhood
groups, or self-help groups).
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
8. Have you ever held any leadership positions in any of these organizations?
Yes No
9. What is your current employment status?
Working Full-time Unemployed, looking for work
Full-time student Working Part-time
Unemployed, not looing Disabled
Homemaker Retired (when: ________________)
10. If currently employed: (If retired, unemployed, homemaker, OR a full-time
student, please answer regarding your last job)
What is your current or most recent occupation:__________________________
________________________________________________________________
By whom are/were you employed:____________________________________
________________________________________________________________
For how long:_____________________________________________________
Describe your job duties: ___________________________________________
________________________________________________________________
-2-
11. Please list your last four occupations and indicate how many years you worked
in each.
1. ____________________________ Years: ___________
2. ____________________________ Years: ___________
3. ____________________________ Years: ___________
4. ____________________________ Years: ___________
12. Have you or someone else close to Yes No
you ever owned a business?
If YES, please identify the person and describe the business, including years of
operation.
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
13. What is your current marital status?
Single (never married) Widowed
Married Divorced
Living with partner (not married) Separated
14. If you are married or have a significant other, please list that person’s current
occupation and employer, and highest level of education:
________________________________________________________________
________________________________________________________________
________________________________________________________________
15. Do you have any hobbies, and if so, what are they?
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16. Do you or your family own or operate a farm?
Yes No
If YES, please identify the kind of farm, size of farm, who owns the farm, and
how long you or your family has owned the farm.
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17. Have you ever owned, operated, or worked on heavy machinery or farm
equipment (e.g., tractors, loaders, skidsteers, backhoes, dump trucks, etc.)?
Yes No
If YES, please explain your experience.
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18. Have you ever owned or operated equipment that used/uses hydraulic fluid of
any kind?
Yes No
If YES, please explain your experience.
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19. Have you ever been trained in the repair of hydraulic systems or tractors of any
kind?
Yes No
If YES, please explain your experience.
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20. Have you ever used or purchased tractor hydraulic fluid?
Yes No
If YES, please explain your experience.
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21. Have you ever purchased a “303” or “yellow bucket” hydraulic fluid? (e.g.,
Super S Super Trac 303, Super S 303, CAM2 Promax 303, CAM2 303,
MileMaster 303, Carquest 303, Lubriguard 303, Napa 303, Coastal 303)?
Yes No
22. Have you ever purchased a Smitty’s Supply, Inc. or CAM2 International, LLC
product (e.g., Engine oil, Gear oil, Transmission fluid, Antifreeze, Hydraulic
fluid?)
Yes No Unsure
If YES, please identify the Smitty’s Supply, Inc. and CAM2 International, LLC
products you have purchased.
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23. Have you ever been involved in a court proceeding?
Yes No
If YES, please describe:
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a) If YES, were you satisfied with the outcome?
Yes No No Outcome
b) Is there anything about that experience that would prevent you from
being fair in this case?
Yes No
24. Have you ever been involved in a court proceeding, settlement, or claims
process involving “303” or “yellow bucket” tractor hydraulic fluid?
Yes No
If YES, please describe:
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25. Please indicate what, if any, prior juror experience you have had.
Civil or Nature of Case When / Foreperson? Did jury
Criminal? (e.g., robbery, Where? (Yes/No) reach a
personal injury) verdict?
(Yes/No)
1
2
3
4
26. Have you, an immediate family member, or a close friend ever filed, been a
witness in, or been sued in a lawsuit?
Yes No
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27. Do you, a family member, or close friend have any relationship with, affiliation
with, personal knowledge of, or employment experience with any of the
following law firms, lawyers, companies, or individuals listed below, either now
or in the past? Mark an “X” next to “Yes” or “No.”
Law Firms Yes No
Companies
Other Individuals Yes No
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28. Do you have any opinions, positive or negative, of any of the law firms,
companies, or individuals listed above?
Yes No
If YES, please explain:
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29. Do you have any education, training, or experience in the following areas?
The law or court system Yes No
Engineering Yes No
Equipment/tractor repair Yes No
Accounting Yes No
Chemistry/fluid Yes No
formulation
Mechanics Yes No
Farming Yes No
Marketing Yes No
If YES, please explain:
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Have you ever had a personal, business, or professional relationship with any of
30. the following companies or organizations: (check all that apply)
Petroleum Quality Institute of America (PQIA)
Petroleum Trends International, Inc (PTI)
Independent Lubricants Manufacturers Association (ILMA)
Missouri Department of Agriculture (MDA)
National Conference of Weights and Measures (NCWM)
Tractor Supply Company
Orscheln Farm and Home, LLC
Rural King Holdings, LLP
Atwoods Distribution, L.P.
If you checked any of the above, please answer the following:
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a. Have you had any especially positive or negative experience(s)
with any of them?
Yes No
If YES, which one(s)?
________________________________________________________________
________________________________________________________________
________________________________________________________________
b. Have you recently heard or read anything about any of them?
Yes No
If YES which one(s), what have you heard or read, and what is the source of
your information?
________________________________________________________________
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________________________________________________________________
c. Do you have an opinion or feeling about any of them?
Yes No
If YES, which one(s) and what is your opinion or feeling?
________________________________________________________________
________________________________________________________________
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31. KNOWLEDGE OF CASE: This is a class action case involving claims of
negligence, breach of implied warranty and Missouri Merchandising Practices
Act arising out of the manufacture and sale of CAM2 Promax 303 Tractor
Hydraulic Fluid which was manufactured by Smitty’s Supply Inc. and sold by
CAM2 International, L.L.C.
a. From news media, conversations with others, or any other source,
have you read, seen, or heard anything about this case or similar cases
involving tractor hydraulic fluid? Yes No
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b. If YES, please describe what you have read, seen, or heard:
________________________________________________________________
________________________________________________________________
________________________________________________________________
c. What sources have provided you with any information about this
case?
________________________________________________________________
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________________________________________________________________
32. What is the major source of news for you?
________________________________________________________________
________________________________________________________________
________________________________________________________________
33. How much time do you spend on social media sites (such as Facebook,
Instagram, Snapchat, Twitter/X, TikTok, etc.)?
I do not use any social media sites
I do not use them daily
Less than 1 hour per day
1-3 hours per day
More than 3 hours per day
34. Do you have any philosophical, moral, ethical, or religious beliefs that would
cause you to have difficulty serving as a juror?
Yes No
If YES, please explain:
________________________________________________________________
________________________________________________________________
________________________________________________________________
35. Is there any matter that has not been covered by this questionnaire concerning
any subject that you feel you should mention at this time that might affect your
ability to serve as a juror in this case?
Yes No
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If YES, please explain:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
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