Fillable Form 1.: California Voter Registration Cancellation Request Form (California)

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Form 1.: California Voter Registration Cancellation Request Form (California)

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California Voter Registration
Cancellation Request Form
FOR OFFICIAL USE ONLY
I,
1.
(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
Condential Information: (Optional) Please provide the following information to ensure that your voter le record can be
accurately identied.
6.
California Driver License
or Identication
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
1225 Fallon Street, Room G-1
Oakland, CA 94612
(510) 272-6973
ALPINE
P.O. Box 158
Markleeville, CA 96120
(530) 694-2281
AMADOR
810 Court Street
Jackson, CA 95642-2132
(209) 223-6465
BUTTE
155 Nelson Ave
Oroville, CA 95965-3411
(800) 894-7761
CALAVERAS
891 Mountain Ranch Road
San Andreas, CA 95249
(209) 754-6376
COLUSA
546 Jay Street, Suite 200
Colusa, CA 95932
(530) 458-0500
CONTRA COSTA
P.O. Box 271
Martinez, CA 94553
(925) 335-7800
DEL NORTE
981 H Street, Room 160
Crescent City, CA 95531
(707) 464-7216
EL DORADO
P.O. Box 678001
Placerville, CA 95667
(530) 621-7480
FRESNO
2221 Kern Street
Fresno, CA 93721
(559) 600-8683
GLENN
516 W. Sycamore Street
2
nd
Floor
Willows, CA 95988
(530) 934-6414
HUMBOLDT
2426 6th Street
Eureka, CA 95501
(707) 445-7481
IMPERIAL
940 W. Main Street, Suite 206
El Centro, CA 92243
(442) 265-1060
INYO
P.O. Drawer F
Independence, CA 93526
(760) 878-0224
KERN
1115 Truxtun Avenue, 1
st
Floor
Bakersfield, CA 93301
(661) 868-3590
KINGS
1400 W. Lacey Blvd., Bldg #7
Hanford, CA 93230
(559) 852-4401
LAKE
255 N. Forbes Street, Room 209
Lakeport, CA 95453
(707) 263-2372
LASSEN
220 S. Lassen Street, Suite 5
Susanville, CA 96130
(530) 251-8217
LOS ANGELES
P.O. Box 1024
Norwalk, CA 90651-1024
(800) 815-2666
MADERA
200 W. 4th Street
Madera, CA 93637
(559) 675-7720
MARIN
P.O. Box E
San Rafael, CA 94913-3904
(415) 473-6456
MARIPOSA
P.O. Box 247
Mariposa, CA 95338
(209) 966-2007
MENDOCINO
501 Low Gap Road, Rm 1020
Ukiah, CA 95482
(707) 234-6819
MERCED
2222 M Street
Merced, CA 95340
(209) 385-7541
MODOC
108 E. Modoc Street
Alturas, CA 96101
(530) 233-6205
MONO
P.O. Box 237
Bridgeport, CA 93517
(760) 932-5537
MONTEREY
P.O. Box 4400
Salinas, CA 93912
(831) 796-1499
NAPA
1127 First Street, Suite E
Napa, CA 94559
(707) 253-4321
NEVADA
950 Maidu Avenue, Suite 210
Nevada City, CA 95959
(530) 265-1298
ORANGE
P.O. Box 11298
Santa Ana, CA 92711
(714) 567-7600
PLACER
P.O. Box 5278
Auburn, CA 95604
(530) 886-5650
PLUMAS
520 Main Street, Room 102
Quincy, CA 95971
(530) 283-6256
RIVERSIDE
2724 Gateway Drive
Riverside, CA 92507-0918
(951) 486-7200
SACRAMENTO
7000 65th Street, Suite A
Sacramento, CA 95823-2315
(916) 875-6451
SAN BENITO
440 Fifth Street, 2
nd
Floor,
Room 205
Hollister, CA 95023-3843
(831) 636-4016
SAN
BERNARDINO
777 E. Rialto Avenue
San Bernardino, CA 92415-0770
(909) 387-8300
SAN DIEGO
P.O. Box 85656
San Diego, CA 92186-5656
(858) 565-5800
SAN FRANCISCO
City Hall
1 Dr. Carlton B. Goodlett Place,
Room 48
San Francisco, CA 94102-4635
(415) 554-4375
SAN
JOAQUIN
P.O. Box 810
Stockton, CA 95201
(209) 468-8683
SAN L UIS OBISPO
1055 Monterey Street, Room D-120
San Luis Obispo, CA 93408
(805) 781-5228
SAN MATEO
40 Tower Road
San Mateo, CA 94402
(650) 312-5222
SANTA BARBARA
P.O. Box 61510
Santa Barbara, CA 93160-1510
(805) 568-2200
SANTA CLARA
P.O. Box 611360
San Jose, CA 95161-1360
(408) 299-8683
SANTA CRUZ
701 Ocean Street,
Room 310
Santa Cruz, CA 95060-4076
(831) 454-2060
SHASTA
P.O. Box 90880
Redding, CA 6099-0880
(530) 225-5730
SIERRA
P.O. Drawer D
Downieville, CA 95936-0398
(530) 289-3295
SISKIYOU
311 Fourth Street, Room 201
Yreka, CA 96097-9910
(530) 842-8084
SOLANO
675 Texas Street,
Suite 2600
Fairfield, CA 94533
(707) 784-6675
SONOMA
P.O. Box 11485
Santa Rosa, CA 95406-1485
(707) 565-6800
STANISLAUS
1021 I Street, Suite 101
Modesto, CA 95354-2331
(209) 525-5200
SUTTER
1435 Veterans Memorial Circle
Yuba City, CA 95993
(530) 822-7122
T EHAMA
P.O. Box 250
Red Bluff, CA 96080-0250
(530) 527-8190
TRINITY
P.O. Box 1215
Weaverville, CA 96093-1215
(530) 623-1220
TULARE
5951 S. Mooney Blvd.
Visalia, CA 93277
(559) 624-7300
TUOLUMNE
2 S. Green Street
Sonora, CA 95370-4618
(209) 533-5570
VENTURA
Hall of Administration, Lower Plaza
800 S. Victoria Avenue
Ventura, CA 93009-1200
(805) 654-2664
YO LO
P.O. Box 1820
Woodland, CA 95776-1820
(530) 666-8133
YUBA
915 8th Street, Suite 107
Marysville, CA 95901-5273
(530) 749-7855
California Secretary of State | (800) 345-VOTE (8683) | www.sos.ca.gov | https://voterstatus.ca.gov
(Rev 8/6/2021)
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Form 1.: California Voter Registration Cancellation Request Form (California)

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Completed 20 May 2022

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