Jury List Affidavit
State of Florida
I _______________________________, do solemnly (or affirm)
that I am ___________ years of age; that I am a citizen of the
United States and a legal resident of Florida and Palm Beach
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:
________________________________________________________
________________________________________________________
Sworn to and subscribed before me this ________ day of
____________, ________, at Palm Beach County Florida.
Year
_______________________________________________
Signature
By: _________________________________
Deputy Clerk