Revocation of Notice of Consent Declaration - Unsolicited Literature on Private Property

Please complete this form if you want to revoke your previously-filed Notice of Consent Declaration for unsolicited or unsubscribed literature, pursuant to Section 5.45.040 SMC. Once filed, your address will be removed from the consent registry.
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Declaration
*

I confirm that all information I entered in this form is accurate and true to the best of my knowledge and that I am the owner, occupier, or manager who filed the original notice of consent for this property.
Signature*

Clear
Date Signed*

MonthDayYear
Date
Please verify that you are human*
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