ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): FOR COURT USE ONLY TELEPHONE NO.: EMAIL ADDRESS (Optional): ATTORNEY FOR (Name): FAX NO.(Optional): SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN DIEGO CENTRAL DIVISION, CIVIL, 330 W. BROADWAY, ROOM 225, SAN DIEGO, CA 92101 APPLICATION OF APPLICATION AND ORDER DECLARING INFORMATION ON AFFIDAVIT OF VOTER REGISTRATION CONFIDENTIAL CASE NUMBER Applicant applies for an order declaring the residence address, telephone number, and email address listed on applicant's affidavit of voter registration declared confidential and not a public record. DECLARATION I, , declare that in accordance with Elec. Code § 2166 a life threatening circumstance exists to me or a member of my household in that: I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: Signature of Applicant ORDER Good cause appearing, the San Diego County Registrar of Voters is ORDERED to keep confidential the residence address, telephone number, and email address information appearing on the affidavit of voter registration of applicant, , pursuant to Elec. Code § 2166. Date: Judge of the Superior Court SDSC CIV-052 (Rev. 10/15) Optional Form APPLICATION AND ORDER DECLARING INFORMATION ON AFFIDAVIT OF VOTER REGISTRATION CONFIDENTIAL Elec. Code § 2166 American LegalNet, Inc. www.FormsWorkFlow.com