At-Risk Designation Form
  • At-Risk Designation Request Form

  • Utah Code 20A-2-606
  • What does this request do?

  • State law allows certain non-government individuals and organizations to obtain some of your voter registration information. This form allows certain individuals to request that their voter registration record is classified as at-risk. Personally identifiable information will not be publicly released. The information that must be provided is the residential/mailing address, party affiliation and age range of the voter.
  • Please provide your personal information:

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  • Utah law only allows certain categories of individuals to withhold their voter registration records from disclosure.
  • Please indicate the category that applies to you:

    **Note: "Public figure" means an individual who, due to the individual being considered for, holding, or having held a position of prominence in a public or private capacity, or due to the individual's celebrity status, has an increased risk to the individual's safety. It also includes an individual who is elected to public office, appointed to fill a vacancy in an elected public office, or employed by a government entity if, in relation to the individual's service in public office or employment as an employee of a government entity, the individual has received a threat of harm to a person or property.
  • I am applying for designation as an at-risk voter because I am, or I reside with:*
  • Read the disclaimer statement below and then sign and date.

  • Submitting this request limits the disclosure of your voter registration record after this form has been processed by the election official. Submitting this form does not remove or prevent the disclosure of your personal information that may be located in other government or commercial databases. Unless you are or likely to be a victim of domestic violence or dating violence, or an individual who resides with an individual who is or likely to be a victim of domestic violence or dating violence, the election official may request additional documentation to verify that you meet the category that you indicated above.

  • Submit this completed form to your county clerk's office or to the Office of the Utah Lieutenant Governor. You may submit this form via mail, email, or you may drop it off in person.

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  • Cache County Clerk's Office

    179 N. Main St, Suite 102

    Logan, UT 84321

    Email: elections@cachecounty.gov

     

    Office of the Utah Lieutenant Governor
    Mailing Address: Utah State Capitol, Suite 220
    PO Box 142325
    Salt Lake City, UT 84114
    Email: elections@utah.gov

  • Form date: 4/26

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