VR-RCVR www.hctax.net Rev 5/15 v3
Request To Cancel Voter Registration
To the Harris County Voter Registrar:
Please cancel my voter registration in Harris County, Texas.
The following is the information printed on my voter registration certificate:
Name: _____________________________________ VUID / Voter ID Number (Optional): _________________
Address: ____________________________________________________________________________________
I understand that the following information is necessary for the Harris County Voter Registrar to properly
identify my records to cancel my voter registration:
Date of birth (mm/dd/yyyy): ____________Texas Driver’s License or Personal I.D. (Optional): ______________
If no TDL or PID, the last 4 digits of my Social Security number, (Optional): _____________________________
I understand that cancellation of my voter registration will not necessarily exclude me from the jury summons
process and does not disqualify me to serve as a juror in the county of my residence.
_______________________________________________________________ _____________________
Signature of voter canceling voter registration in Harris County or Date
printed name of voter and relationship to the voter, if signed by a witness
Instructions for witness:
If the person required to sign this document cannot sign their name because of physical disability or illiteracy,
they must affix their mark to the document and a witness must attest the mark.
If the person cannot make their mark, the witness shall check here _____.
Submit completed form by mail to:
Ann Harris Bennett
Harris County Tax Assessor-Collector and Voter Registrar
1001 Preston Suite 200
Houston, Texas 77002
or by fax to: 713-368-2309
ANN HARRIS BENNETT
Tax Assessor-Collector & Voter Registrar
