Notification of Deceased Voter

San Francisco Residents Only

To notify the Department of Elections that a voter has passed away, complete and submit this form.

Information about deceased voter:

Full name

Date of birth

Date of death

Address where registered

Zip Code

Information about person notifying the Department of Elections:

Full name

Relationship to deceased voter

Contact information (telephone number / email address, in case we must contact you)

Home address

Comments:

As a safeguard against errors, the Department will verify the information provided about the deceased voter against public health records. If the information cannot be verified, the Department will mail a notice of cancellation to the address of the deceased voter.

The Department of Elections appreciates your contacting us to update this record.

By clicking “Submit,” I declare under penalty of perjury under the laws of the State of California that the information on this form is true and correct.