Maryanne Morse Clerk of the Circuit Court Seminole County
Attn: Jury Management Post Office Box 8099 Sanford, Florida 32772-0659 (407) 665-4500		Clerk of the Circuit Court Clerk of the County Court Clerk to the Board of County Commissioners

Instructions: (1) Print this page (2) Fill in the information requested and have it notarized (3) Mail to the above address.

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 Seminole 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:

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Signature

Sworn to and subscribed before me this _____ day of ______________ (month), _____ (year), at Seminole County, Florida.





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(Deputy Clerk/Notary Public)