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    Cancellation Request Formm

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    felixcalderon562
    This document is a voter registration cancellation request form from California. It requests the voter's name, date of birth, residence address, mailing address if different, driver's license or ID number, and last 4 digits of their social security number. It informs the voter to sign and date the form before returning it to their county elections office to cancel their voter registration, as authorized by California elections code. It then lists the addresses for all California county elections offices.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Cancellation Request Formm

    Uploaded by

    felixcalderon562
    7 views2 pages
    This document is a voter registration cancellation request form from California. It requests the voter's name, date of birth, residence address, mailing address if different, driver's license or ID number, and last 4 digits of their social security number. It informs the voter to sign and date the form before returning it to their county elections office to cancel their voter registration, as authorized by California elections code. It then lists the addresses for all California county elections offices.

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    This document is a voter registration cancellation request form from California. It requests the voter's name, date of birth, residence address, mailing address if different, driver's license or ID number, and last 4 digits of their social security number. It informs the voter to sign and date the form before returning it to their county elections office to cancel their voter registration, as authorized by California elections code. It then lists the addresses for all California county elections offices.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    7 views2 pages

    Cancellation Request Formm

    Uploaded by

    felixcalderon562
    This document is a voter registration cancellation request form from California. It requests the voter's name, date of birth, residence address, mailing address if different, driver's license or ID number, and last 4 digits of their social security number. It informs the voter to sign and date the form before returning it to their county elections office to cancel their voter registration, as authorized by California elections code. It then lists the addresses for all California county elections offices.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    FOR OFFICIAL USE ONLY

    California Voter Registration


    Cancellation Request Form

    1. I, (full name, as registered to vote), would like to cancel my voter


    registration. Please cancel my registration, as authorized by California Elections Code section 2201 (a).

    2.
    Print Full Legal Name:
    (as used to register to vote) First / Middle Name or Initial / Last

    3. Date of Birth:
    Month / Day / Year

    4. Complete
    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

    5. Mailing Address:
    (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.

    6. California Driver License


    or Identification
    Card Number:

    7. Social Security,
    Last 4 Numbers:

    Signature: Date:

    Please sign and date this form and return to your county elections
    office. Questions? Contact your county elections office.
    CALIFORNIA COUNTY ELECTIONS OFFICES
    ALAMEDA K I NG S PLACER SHAST A
    1225 Fallon Street, Room G-1 1400 W. Lacey Blvd., Bldg #7 P.O. Box 5278 P.O. Box 90880
    Oakland, CA 94612 Hanford, CA 93230 Auburn, CA 95604 Redding, CA 6099-0880
    (510) 272-6973 (559) 852-4401 (530) 886-5650 (530) 225-5730

    A L P IN E LAKE
    PLUMAS S I E R RA
    P.O. Box 158 255 N. Forbes Street, Room 209
    Lakeport, CA 95453 520 Main Street, Room 102 P.O. Drawer D
    Markleeville, CA 96120 Quincy, CA 95971 Downieville, CA 95936-0398
    (530) 694-2281 (707) 263-2372
    (530) 283-6256 (530) 289-3295
    LASSEN
    AMADOR 220 S. Lassen Street, Suite 5 RIVERSIDE SISKIYOU
    810 Court Street Susanville, CA 96130 2724 Gateway Drive 311 Fourth Street, Room 201
    Jackson, CA 95642-2132 (530) 251-8217 Riverside, CA 92507-0918 Yreka, CA 96097-9910
    (209) 223-6465 (951) 486-7200 (530) 842-8084
    LOS A N G E LE S
    BUTTE P.O. Box 1024 SACRAMENTO SOLANO
    155 Nelson Ave Norwalk, CA 90651-1024 7000 65th Street, Suite A 675 Texas Street, Suite 2600
    Oroville, CA 95965-3411 (800) 815-2666 Sacramento, CA 95823-2315 Fairfield, CA 94533
    (800) 894-7761 (916) 875-6451 (707) 784-6675
    MADERA
    CALAVERAS 200 W. 4th Street
    SAN BENITO S ON OM A
    891 Mountain Ranch Road Madera, CA 93637
    440 Fifth Street, 2 nd Floor, P.O. Box 11485
    San Andreas, CA 95249 (559) 675-7720
    Room 205 Santa Rosa, CA 95406-1485
    (209) 754-6376 Hollister, CA 95023-3843 (707) 565-6800
    M A RI N
    P.O. Box E (831) 636-4016
    COLUSA S TA NI S LAUS
    San Rafael, CA 94913-3904
    546 Jay Street, Suite 200 SAN BE R N A R D I N O 1021 I Street, Suite 101
    (415) 473-6456
    Colusa, CA 95932 777 E. Rialto Avenue Modesto, CA 95354-2331
    (530) 458-0500 MARIPOSA San Bernardino, CA 92415-0770 (209) 525-5200
    P.O. Box 247 (909) 387-8300
    CONTRA COSTA Mariposa, CA 95338 SUTTER
    P.O. Box 271 (209) 966-2007 SAN DI E G O 1435 Veterans Memorial Circle
    Martinez, CA 94553 P.O. Box 85656 Yuba City, CA 95993
    (925) 335-7800 MEND OCI N O San Diego, CA 92186-5656 (530) 822-7122
    501 Low Gap Road, Rm 1020
    (858) 565-5800
    DEL NORT E Ukiah, CA 95482 T EH AM A
    981 H Street, Room 160 (707) 234-6819 SAN FR A N C I S C O P.O. Box 250
    Crescent City, CA 95531 City Hall Red Bluff, CA 96080-0250
    MERCED
    (707) 464-7216 1 Dr. Carlton B. Goodlett Place, (530) 527-8190
    2222 M Street
    Merced, CA 95340 Room 48
    EL D ORAD O TR IN IT Y
    (209) 385-7541 San Francisco, CA 94102-4635
    P.O. Box 678001 (415) 554-4375 P.O. Box 1215
    Placerville, CA 95667 MODOC Weaverville, CA 96093-1215
    (530) 621-7480 108 E. Modoc Street SAN JOA QUI N (530) 623-1220
    Alturas, CA 96101 P.O. Box 810
    FRESNO (530) 233-6205 TULARE
    Stockton, CA 95201
    2221 Kern Street 5951 S. Mooney Blvd.
    MONO (209) 468-8683 Visalia, CA 93277
    Fresno, CA 93721
    (559) 600-8683 P.O. Box 237 (559) 624-7300
    Bridgeport, CA 93517 SAN L UIS OBI S P O
    GLENN (760) 932-5537 1055 Monterey Street, Room D-120 TUOLUMNE
    516 W. Sycamore Street San Luis Obispo, CA 93408 2 S. Green Street
    MONT E RE Y (805) 781-5228 Sonora, CA 95370-4618
    2nd Floor P.O. Box 4400
    Willows, CA 95988 (209) 533-5570
    Salinas, CA 93912 SAN MATEO
    (530) 934-6414 (831) 796-1499 40 Tower Road VENTURA
    San Mateo, CA 94402 Hall of Administration, Lower Plaza
    H U M B O LD T NAPA (650) 312-5222 800 S. Victoria Avenue
    2426 6th Street 1127 First Street, Suite E
    Eureka, CA 95501 Napa, CA 94559 Ventura, CA 93009-1200
    SANTA B A R B A R A
    (707) 445-7481 (707) 253-4321 (805) 654-2664
    P.O. Box 61510
    NEVADA Santa Barbara, CA 93160-1510 YO LO
    I M P ER IAL
    950 Maidu Avenue, Suite 210 (805) 568-2200 P.O. Box 1820
    940 W. Main Street, Suite 206
    El Centro, CA 92243 Nevada City, CA 95959 Woodland, CA 95776-1820
    (530) 265-1298 SANTA CLARA
    (442) 265-1060 (530) 666-8133
    P.O. Box 611360
    ORANGE San Jose, CA 95161-1360 YUBA
    INYO
    P.O. Box 11298 (408) 299-8683 915 8th Street, Suite 107
    P.O. Drawer F
    Santa Ana, CA 92711 Marysville, CA 95901-5273
    Independence, CA 93526
    (714) 567-7600 SANTA CRUZ (530) 749-7855
    (760) 878-0224
    701 Ocean Street, Room 310
    KERN Santa Cruz, CA 95060-4076
    (831) 454-2060
    1115 Truxtun Avenue, 1st Floor
    Bakersfield, CA 93301
    (661) 868-3590

    California Secretary of State | (800) 345-VOTE (8683) | www.sos.ca.gov | https://voterstatus.sos.ca.gov


    (Rev 8/6/2021)

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