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 (requiresobituaryordeathcertificate).

/ / /

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.

General Authority: SDCL 12-1-9 (1), 12-4-56 .

Law Implemented: SDCL 12-4-8 , 12-4-12 , 12-4-18 , 12-4-56 .