STATE OF FLORIDA,
COUNTY OF
I do solemnly swear (or affirm) that my name is ; that I am years old; that I was born in the State of ; that I am registered to vote; that I am a qualified voter of the county and state aforesaid and have not voted in this election.
(Signature of voter)
Sworn to and subscribed before me this day of, A. D. (year) .
(Clerk or inspector of election)
Precinct No.
County of
Fla. Stat. § 101.49
Former s. 100.35.