Request For Voter Registration Cancellation

FULTON COUNTY CLERK
P. O. BOX 226
LEWISTOWN, IL 61542
PHONE 309-547-3041 EXT 117
FAX 309-547-3326

REQUEST FOR VOTER REGISTRATION CANCELLATION- FULTON COUNTY, IL.

I hereby request my voter registration to be canceled in Fulton County, Illinois

Name (Print): __________________________________________

Fulton County street address: _____________________________________

City: _____________________________

Zip: ____________

Date of Birth: __________________________

Phone #: ____________________________

Signature: ______________________________

Date: _______________________________
Please mail completed form to Fulton County Clerk, P.O. Box 226, Lewistown, Illinois 61425 If you have any questions, please call Fulton County Election Dept. at 309-547-3041 Ext 119 or 120

REQUEST-FOR-VOTER-REGISTRATION-CANCELLATION