Notification (To Registrar Of Voters) Of Disqualification From Voting {13-14523-360}

ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): FOR COURT USE ONLY TELEPHONE NO.: E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): FAX NO. (Optional): SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN BERNARDINO STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: TITLE OF CASE: CASE NUMBER: HEARING DATE: CONSERVATORSHIP NOTIFICATION TO REGISTRAR OF VOTERS AND THE SECRETARY OF STATE OF DISQUALIFICATION FROM VOTING Name of Conservatee: Street Address: City: Last four digits of Conservatee's SSN: California Driver License/Identification Card number: Conservatee's date of birth: State: Zip: NOTIFICATION TO REGISTRAR OF VOTERS OF DISQUALIFICATION FROM VOTING 13-14523-360, Rev. 052416 American LegalNet, Inc. www.FormsWorkFlow.com