PETITION TO HAVE VOTER Elections Code 247247 2166 LASC CIV 27 NEW 06/19 For Mandatory Use REGISTRATION INFORMATION DECLARED CONFIDENTIAL NAME , ADDRESS, AND EMAIL ADDRESS OF P ETITIONER OR ATTORNEY : TELEPHONE: Reserved for Clerk222s File Stamp SUPERIOR COURT OF CALIFORNIA, COUNTY OF LOS ANGELES COURTHOUSE ADDRESS: 111 N. Hill Street Los Angeles, CA 90012 P ETITIONER (Name ) : RESPONDENT : County Registrar - Recorder/County Clerk PETITION TO HAVE VOTER REGISTRATION INFORMATION DECLARED CONFIDENTIAL CASE NUMBER: I, , hereby petition the court for an order to declare the residence address, telephone number and email address appearing on my affidavit of registration as a voter to be deemed confidential information. I am requesting this order because it is necessary to protect me or a member of my household from a life-threatening circumstance (provide explanation below): Explanation (Use additional sheet if necessary): I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Signature of Petitioner Date American LegalNet, Inc. www.FormsWorkFlow.com