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UNITED STATES DISTRICT COURT

DISTRICT OF ARIZONA

JUDGE RAYES’

CONFIDENTIAL JUROR QUESTIONNAIRE

STATEMENT OF THE CASE:

Plaintiff Montiah Chatman alleges that, on or about January 4, 2017, Defendants Marci 

Ferrell and Cindy Chrisman, employees at the Arizona Department of Child Services 

(“ADCS”), under the direction of John Sullivan of the Arizona Attorney General’s Office,

unlawfully removed her children from her home in violation of her and her sons’ Fourth 

Amendment rights and in violation of Arizona State law. Defendants deny removal was 

unlawful. 

**Please do not write on the back of this questionnaire.

1. Have you read or heard anything about the facts of this case? ____

2. Given this brief recitation of facts, is there anything about these circumstances that 

would cause you to believe you could not consider the evidence fairly, impartially, 

and according to the law? 

3. Have you or any member of your family ever been involved in a case like this?

4. Full Name:

5. Age:

6. Complete Address:

7. Where do you work? (If retired, where did you work just before you retired?)

8. What kind of work do you do? (If retired, what was the nature of work you last did?)

9. What is or was your most recent job title?

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10. Please state any other jobs you have had in the last five years: 

11. What level of school did you finish? ________Describe any degrees you have 

received. 

12. Are you married? ____ (If yes, what type of work does your spouse do? If he/she is 

retired, what was the nature of the work he/she did prior to retirement?)

13. If you have children, please state their ages and, if they work, what is the occupation 

of each? 

14. Have you ever served in the military? ____ If yes, which branch and for how long? 

15. A. Have you ever served on a jury before? ____ If yes, please state the type of case, 

whether it was in state or federal court, whether a verdict was reached and, without 

stating what your verdict was, what was the verdict of the jury?

B. If applicable, is there anything in your previous jury service that would influence 

you in deciding the issues in this case? 

16. Have you ever served on a Grand Jury? ____ If yes, when? 

17. What print or digital publications and websites do you read or follow regularly? 

18. If you watch television, what shows do you watch regularly? 

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19. If you have bumper stickers on your vehicle, state the content of them. 

20. If you belong to civic, social, fraternal, union, or professional organizations, please 

state which ones. 

21. It is expected that trial will be conducted March 8, 2021 and will conclude on March 

11, 2021. Trial will be held Tuesday through Friday for the 2 consecutive weeks. 

Jury deliberations could go beyond this date. Would this schedule and/or length of

trial create any undue hardship for you? ____ If yes, please explain in detail. 

 

22. Have you or any immediate family members ever been involved in a lawsuit?

____ If so, 

a. what was that person’s relationship to you

b. nature of the lawsuit, 

c. what was the outcome of the case, and 

d. was there anything about that experience that might make it difficult for you 

to sit as a fair and impartial juror in this case?

23. Is there anything that the lawyers or the judge should know about you that has not 

been asked in these questions? 

QUESTIONS RE: COVID-19 PANDEMIC:

1. Have you developed flu-like symptoms (cough, fever or shortness of breath) within 

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the last 14 days? ____Yes ____No 

2. Have you been in contact with anyone who has been diagnosed with a COVD-19 

infection or who has exhibited symptoms of a COVID–19 infection within the last 

14 days? ____Yes ____No 

3. Are you or is anyone in your household a healthcare worker directly involved in the 

treatment of COVID-19 patients? ____Yes ____No 

If you answered “yes” to any of the above questions, do you believe it may affect 

your duty as a juror such that it would make it difficult for you to be a fair, impartial 

and attentive juror? Briefly explain: 

4. Are you or is anyone in your household at high risk for complications from 

contracting COVID–19 due to pre-existing conditions (age, or other 

characteristics)? ____Yes ____No 

If yes, do you believe it may affect your ability to be a fair, impartial and attentive 

juror? Briefly explain: 

If you answered no to the above questions relating to COVID-19, do you have 

concerns about COVID-19 such that you believe it might affect your duties as a 

juror or that it would make it difficult to be a fair, impartial, and attentive juror? 

Please explain: 

5. The Chief Judge of the District Court has issued an order requiring everyone 

entering the Courthouse to wear a mask covering his or her nose and mouth at all 

times while in the building. Would you have any difficulty complying with that 

order?____ If, so explain in detail. 

I declare, under penalty of perjury, that all answers are true and correct to the best of my 

knowledge.

_________________________________

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Signature

_________________________________

Date

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