Transcription of I no longer wish to be registered to vote in Pennsylvania.
1 VOTER REQUEST TO CANCEL REGISTRATION. INSTRUCTIONS. This form can only be completed by the voter. You may voluntarily cancel your voter registration by completing this form. Please mail or deliver to your county voter registration office. To find a list of these offices, please see page 2. STEP 1: STEP 2: STEP 3: Fill out the form Sign and date the form Mail or deliver to your county voter registration office I no longer wish to be registered to vote in Pennsylvania. Last name Jr Sr ll lll lV (Circle if applicable). Printed Name First name Middle name or initial Identification PA driver's license or PennDOT ID card number This information will only be used to or locate your record Last four digits of your Social Security number X X X - X X - on file and process your request. Your ID information will Date of birth / / MM/DD/YYYY. be confidential. Street Address (Not Box) Apt. Number Address Please write the address City/Town State PA Zip Code where you are registered to vote in Pennsylvania.
2 Municipality County Contact Please add your Phone - - (Optional). contact information in case there are any questions. Email (Optional). Signature Date False statements on this form are punishable pursuant to 18 4904 (relating to unsworn ! NOTICE falsification to authorities). PAGE 1 PA-DOS VRCAN Pennsylvania County Voter Registration Office addresses PA-DOS VRAD Adams Chester Fulton Mercer Susquehanna 117 Baltimore St 601 Westtown Rd 116 W Market St 130 North Pitt Street, Ste B PO Box 218. Rm 106 Ste 150 Ste 205 Mercer PA 16137-1227 31 Lake Ave Gettysburg PA 17325 PO Box 2747 McConnellsburg PA 17233 (724) 662-7542 Montrose PA 18801. (717) 337-9832 West Chester PA 19380-0990 (717) 485-6872 (570) 278-6697. (610) 344-6410 Mifflin Allegheny Greene 20 N Wayne St Lewistown Tioga 542 Forbes Ave Clarion 93 E High St PA 17044 (717) 248-6571 118 Main St Ste 609 Administrative Building Rm 102 Wellsboro PA 16901. Pittsburgh PA 15219-2913 330 Main St Waynesburg PA 15370 Monroe (570) 723-8230.
3 (412) 350-4500 Rm 104 (724) 852-5230 One Quaker Plaza Clarion PA 16214 Rm 105 Union Armstrong (814) 226-4000 Ext 2006 Huntingdon Stroudsburg PA 18360 155 N 15th St Administration Bldg Bailey Building (570) 517-3165 Lewisburg PA 17837-8822. 450 E Market St Clearfield 233 Penn St (570) 524-8681. Ste 207 212 E Locust St Huntingdon PA 16652-1486 Montgomery Kittanning PA 16201 Ste 106 (814) 643-3091 Ext 205 Voter Services Venango (724) 548-3222 Clearfield PA 16830 PO Box 311 1174 Elk St (814) 765-2642 ext 5053 Indiana Norristown PA 19404-0311 PO Box 831. Beaver 825 Philadelphia St (610) 278-3280 Franklin PA 16323-0831. 810 Third St Clinton Indiana PA 15701-3934 (814) 432-9514. Beaver PA 15009 2 Piper Way (724) 465-3852 Montour (724) 770-4440 Ste 309 435 East Front St Danville Warren Lock Haven PA 17745 Jefferson PA 17821 204 4th Ave Bedford (570) 893-4019 155 Main St (570) 271-3002 Warren PA 16365. 200 S Juliana St Jefferson Place (814) 728-3406.
4 3rd Fl Columbia Brookville PA 15825-1269 Northampton Ste 301 PO Box 380 (814) 849-1693 Elections Division Washington Bedford PA 15522 Bloomsburg PA 17815-0380 669 Washington St Easton 100 W Beau St (814) 623-4807 (570) 389-5640 Juniata PA 18042 Rm 206. 1 N Main St (610) 829-6260 Washington PA 15301. Berks Crawford PO Box 68 (724) 228-6750. 633 Court St 903 Diamond Park Mifflintown PA 17059 Northumberland 1st Fl Meadville PA 16335 (717) 436-7706 320 N 2nd St Wayne Reading PA 19601 (814) 333-7307 Ste 1 925 Court St (610) 478-6490 Lackawanna Sunbury PA 17801 Honesdale PA 18431. Cumberland 123 Wyoming Ave (570) 988-4208 (570) 253-5978. Blair 1601 Ritner Highway 2nd Floor 423 Allegheny St Ste 201 Scranton PA 18503 Perry Westmoreland Ste 043 Carlisle PA 17013 (570) 963-6737 PO Box 37 2 N Main St Hollidaysburg PA 16648-2022 (717) 240-6385 New Bloom ield PA 17068 Ste 109. (814) 693-3150 Lancaster (717) 582-2131 ext 4110 Greensburg PA 15601. Dauphin PO Box 2139 (724) 830-3150.
5 Bradford 1251 South 28th Street Lancaster PA 17608 Philadelphia 6 Court St Harrisburg, PA 17111 (717) (717) 299-8293 520 N Columbus Blvd Wyoming Ste 2 780-6360 Philadelphia PA 1 Courthouse Sq Towanda PA 18848 Lawrence 19123-4295 Tunkhannock PA 18657. (570) 265-1717 Delaware 430 Court St (215) 686-1590 (570) 996-2226. Govt Center Bldg New Castle PA 16101. Bucks 201 W Front St (724) 656-2161 Pike York 55 E Court St Media PA 19063-2728 506 Broad St 28 E Market St Doylestown PA 18901-4318 (610) 891-4659 Lebanon Milford PA 18337 York PA 17401-1579. (215) 348-6163 400 S 8th St (570) 296-3427 (717) 771-9604. Elk Municipal Bldg Butler 300 Center St Rm 209 Potter PO Box 1208 PO Box 448 Lebanon PA 17042 1 N Main St Butler PA 16003 Ridgway PA 15853-0448 (717) 228-4428 Ste 204. Coudersport PA 16915 For a listing of available (724) 284-5308 (814)776-5337 email addresses, go to Lehigh (814) 274-8467. Cambria Erie 17 S 7th St 200 S Center St 140 W 6th St Allentown PA 18101-2401 Schuylkill Ebensburg PA 15931 Rm 112 (610) 782-3194 420 N Centre St Pottsville (814) 472-1464 Erie PA 16501 PA 17901.
6 (814) 451-6276 Luzerne (570) 628-1467. Cameron 20 N Pennsylvania Ave 20 E Fifth St Fayette Ste 207 Snyder Emporium PA 15834-1469 2 W Main St., Ste. 111 Wilkes-Barre PA 18701 PO Box 217. (814) 486-9321 Public Service Bldg Uniontown (570) 825-1715 Middleburg PA 17842-0217. PA 15401 (570) 837-4207. Carbon (724) 430-1289 Lycoming 44 Susquehanna St 48 W Third St Somerset PO Box 170 Forest Williamsport PA 17701-9536 300 N Center Ave Jim Thorpe PA 18229-0170 526 Elm St (570) 327-2267 Ste 340. (570) 325-4801 Box 3 Somerset PA 15501 (814). Tionesta PA 16353 McKean 445-1549. Centre (814) 755-3537 500 W Main St 420 Holmes St Smethport PA 16749 Sullivan Willowbank Office Bldg Franklin (814) 887-3203 245 Muncy St Bellefonte PA 16823-1486 272 N. Second Street PO Box 157. (814) 355-6703 Chambersburg, PA 17201 Laporte PA 18626. (717) 261-3886 (570) 946-5201 ext 7. PAGE 2.
