California Voter Registration Cancellation Request Form
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1
2FOR OFFICIAL USE ONLY
California Voter Registration
Cancellation Request Form
I,
(full name, as registered to vote), would like to cancel my voter
1 .
registration. Please cancel my registration, as authorized by California Elections Code section 2201 (a).
2 .
Print Full Legal Name:
First / Middle Name or Initial / Last
(as used to register to vote)
3 .
Date of Birth:
Month / Day / Year
Complete
4 .
Residence Address:
(as used to register to vote)
Number and Street (P.O. Box, Rural Route, etc. will not be accepted) (Designate N,S,E,W if used)
City / Zip Code / California County
Mailing Address:
5 .
(if different from above)
Number and Street (Designate N,S,E,W if used)
City / State or Foreign County / Zip Code or Postal Code
Confidential Information: (Optional) Please provide the following information to ensure that your voter file record can be
accurately identified.
California Driver License
6 .
or Identification
Card Number:
Social Security,
7 .
Last 4 Numbers:
Signature:
Date:
Please sign and date this form and return to your county elections
office. Questions? Contact your
county elections
office.
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Parent category: Legal