FORM SUMMARY Name of Form Notice to State Election Board Form Number GN-3180 Statutory Reference §§54.25(2),(c),(1),(g) and 54.64(2) ,Wisconsin Statutes Benchbook Reference GA-1, GA-2 Purpose of Form Inform the state elections board of a determination on competency to vote or register to vote. Who Completes It: Register in Probate. Distribution of Form Original to the State Election Board. Copy to court. Accompanying Forms: New Form/Modification: Modified; last update 10/06. Modifications: Eliminated “is competent and” prior to the sentence “has been restored the right to….” Comments: About this Form: This form is the product of the Wisconsin Records Management Committee, a committee of the Director of State Court's Office and a mandate of the Wisconsin Judicial Conference. If you have additional information that does not change the meaning of the form, attach it on a separate page. The form itself shall not be altered. Date: 04/19/2007 Page 1 American LegalNet, Inc. www.FormsWorkflow.com For Official Use COUNTY STATE OF WISCONSIN, CIRCUIT COURT, Amended IN THE MATTER OF Notice to State Election Board Case No. Date of Birth TO: STATE ELECTIONS BOARD Attn: Statewide Voter Registration Service P. O. Box 2973 Madison, Wisconsin 53701-2973 that: This is to notify you that a circuit court declared on (date) Party/full name: Party/primary address: Party/second address: Party/city Party/State Party/zip: Date of birth: is not competent to exercise the right to register to vote or to vote in an election. has been restored the right to register to vote and to vote in an election. Signature of Register in Probate Name Printed or Typed Street Address Name of Attorney City, State, Zip Address Date Telephone Number Bar Number Telephone Number GN-3180, 04/07 Notice to State Election Board §§54.25(2)(c)(1)(g) and 54.64(2) ,Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. American LegalNet, Inc. www.FormsWorkflow.com