05:02:21:01Voter cancellation form.

A county auditor shall use the following form when a voter voluntarily cancels the voter's voter registration or when informed of the death of a voter: To cancel your voter record in South Dakota's Statewide Voter Registration System, or inform the County Auditor of a voter’s death, complete and sign this form, and return it to your County Auditor. County Auditor contact information: https://vip.sdsos.gov/CountyAuditors.aspx Voter's Printed Name: First________________ Middle________________ Last Name________________ Date of Birth: ____/___/______ Phone Number________________ MM DD YYYY Residential Address: Street Address______________________________________ City, State, and Zip Code______________________________ Last Four Digits of SSN:________ AND Driver's License #/Non-Driver ID #:_____________ I hereby request the above voter be removed from the South Dakota list of registered voters for one of the following reasons: 1 I, the undersigned, have moved out of state (requires voter's signature or mark); 1 I, the undersigned, request that my name be removed (requires voter's signature or mark); 1 The voter is deceased (requires obituary or death certificate). / / / Signature* Date Relationship to Deceased Voter Phone / Email if County has Questions *If your registered name is different from your current name, please sign both last names. I declare, under penalty of perjury (2 years imprisonment and $4,000 fine), that I am the voter listed above or I am submitting true and correct information about a deceased voter. Please sign, date, and return this form to your county auditor via mail or in person. Electronic submissions are not allowed.

Source: 50 SDR 12, effective August 8, 2023.