Remove voter from by mail ballot

I, Enter Legal Name* , do hereby request to no longer receive my ballot by mail.
Date of Birth*

MonthDayYear
Date
Last 4 of SSN*
Read and Sign Below

I do swear (or affirm), subject to penalty of law for false statements, that the information contained in this form is true, and that I am a qualified voter residing in CACHE County, UT.
Signature*

Clear
Date

MonthDayYear
Date
Should be Empty: