(Copy Receipt) SUPERIOR COURT OF WASHINGTON COUNTY OF SPOKANE (Clerk’s Date Stamp) CASE NO. ________________________ In the Guardianship of: NOTICE OF LOSS OF VOTING RIGHTS ___________________________________ Incapacitated Person (CLERK’S ACTION REQUIRED – send Notice to County Auditor) On_________________________, this matter came before the court. Pursuant to Laws of Washington RCW 11.88.010, it has been determined that the individual named in this notice lacks the capacity to understand the nature and effect of voting. The court has appointed a guardian and has revoked the right to vote. Name:______________________________________ Date of Birth: _________________ Address: _____________________________________________________________________ SIGNED at ________________, Washington this ______ day of ________________, 20_____ Signature of Petitioner Printed Name/WSBA/CPG# Address City, State, Zip Code *Telephone/Fax Number Email Address *Under GR 22 (b) (6), parties’ personal telephone number(s) are confidential information. If you do not want your personal phone number(s) on this public form, complete form #S2-Sealed Confidential Information and file in the confidential file. I hereby certify that I personally mailed the above notice to the Auditor of the county in which the incapacitated person resides on _______________. ______________________________________ Deputy Clerk, Spokane County Superior Court #12-NOTICE OF LOSS OF VOTING RIGHTS PAGE 1 OF 1 Revised 3/07 American LegalNet, Inc. www.FormsWorkflow.com