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Dallas County Official Voter Registration Cancelation Form Fill out form and mail in an envelope to: Dallas County Auditor, 210 N. 10th, Adel, IA 50003 REQUEST TO CANCEL VOTER REGISTRATION ID Number Provide your Iowa driver’s Iowa driver’s license license, non-operator ID Iowa non-operator ID number, OR the last 4 Last 4 digits of Social Security number: XXX-XX- digits of your Social Security I do not have an IA driver’s license, non-operator ID, or Social Security number. number if you have one. Additional Date of Birth (month, day, year) Information Sex Male Female (Date of birth and sex Phone and/or Email are required) (optional) Your Name Last First Middle Most Recent Dallas County Street Registration (include apartment, unit, lot, etc.) Address Zip County: Dallas (if homeless or you do not have an established residence, describe where you reside: Voter Affidavit I hereby request that my voter registration in Dallas County, Iowa, be cancelled. I affirm that the information I have provided is accurate to the best of my knowledge. Signature: Date: