(1) The Department of Highway Safety and Motor Vehicles shall deliver quarterly to the clerk of the circuit court in each county a list of names of persons who reside in that county, who are citizens of the United States, who are legal residents of Florida, who are 18 years of age or older, and for whom the department has a driver’s license or identification card record. The clerk of the circuit court shall add to the list the name of any person who is 18 years of age or older and who is a citizen of the United States and a legal resident of Florida and who indicates a desire to serve as a juror, but whose name does not appear on the department list, by requiring such person to execute an affidavit at the office of the clerk.
(2) The affidavit executed pursuant to subsection (1) must be in substantially the following form:
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)
Sworn to and subscribed before me this day of , (year) , at County, Florida.
(Signature and title of officer