Summary
Please completely fill in form and print out. If completing by hand, please print. This form requires the requester's complete information including driver's license and address. If the requester is a business it also requires information about that business. You must give your justification — i.e. why you want the information and how that information will be used.
View the PDF and electronic forms
This form may not work with all assistive technology and is being remediated. For alternative formats, please email Elections Department or phone 415-473-6456. To use the California relay service, dial 711.