REQUEST TO CANCEL VOTER REGISTRATION

REQUEST TO CANCEL VOTER REGISTRATION
Full name (including middle name and any suffix)*
Date of Birth*

MonthDayYear
Driver's License, ID Number, or last 4 digits of your SSN*
DC Voter Registration Address*
Please select one of the following reasons to cancel your voter registration:

You are moving out of the District of Columbia.You no longer wish to be a registered voter in the District of Columbia.
I swear or affirm that the voter registration information provided above is true and accurate to the best of my knowledge. I hereby request that my District of Columbia voter registration be cancelled, effective as of the date that this form is received by the Board of Elections. I understand that I will no longer be eligible to vote in the District of Columbia unless re-apply for registration.
Signature*

Clear
Date*

MonthDayYear
If you are unable to sign, you must make a mark in the signature space above, and a witness to the mark must complete the line below:
Witness Printed Name
Witness Signature

Clear
Date

MonthDayYear
Should be Empty: