State of Florida
I,, do solemnly swear (or affirm) that I am years of age; that I am a citizen of the United States and a legal resident of Florida and County; that I personally make application for jury duty; that I am eligible to serve as a juror under the Constitution and laws of Florida; and that I reside at (Address) .
(Signature)
Sworn to and subscribed before me this day of, (year) , at County, Florida.
(Signature and title of officer administering oath)
Fla. Stat. § 40.011