Sample Ballot Pamphlet Opt-Out Form

All fields with an asterisk (*) are required.
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Name as Registered *

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Date of Birth *

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Email Address *

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Residence Address *

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Mailing Address

If different from Residence Address.

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Sample Ballot Pamphlet Options *

Sample Ballot Pamphlet Options

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Authorization *

Enter California Driver License or Identification Card Number

Enter Last Four Digits of Your Social Security Number