If a written summons for jury duty allows a person to claim a disqualification or exemption by signing a statement and returning it to the clerk of the court, the form must notify the person that by claiming a disqualification or exemption based on:
(1) the lack of citizenship, the person will no longer be eligible to vote if the person fails to provide proof of citizenship; or
(2) lack of residence in the county, the person might no longer be eligible to vote in the county.