Request Name be Removed from Official Voter Records

Request Name be Removed from Official Voter Records
I, Enter Full Legal Name*, do hereby request that my name be removed from the Official Register of Cache County and the State of Utah.
I want to be removed for the following reasons:*

I have moved from the state of Utah.I no longer want to be a registered voter in the state of Utah.
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 I understand that by signing this form I will be removed from Cache County's voter rolls.
Signature*

Clear
Today's Date

MonthDayYear
Date
Should be Empty: