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To: Municipal Clerks & Registrars

From: Julie Flynn, Deputy Secretary of State

Re: Immediate Family Member Notice of Voter’s Death

Date: May 3, 2021

NEW Immediate Family Member Notice of Voter’s Death Form

In 2020, a new law (PL 2019, c. 636, §1) authorized the Secretary of State to design a form that would allow an immediate family member to provide notice of death of a registered voter. The newly created form, illustrated on the reverse side, has been approved by the Secretary of State as an additional confirmed source to cancel a deceased voter’s record in CVR.

• NEW Immediate Family Member Notice of Voter’s Death form

The new form must be completed by an immediate family member as defined in Title 21-A §1(20):

"Immediate family" means a person's spouse, parent, grandparent, child, grandchild, sister, half-sister,

brother, half-brother, stepparent, step-grandparent, stepchild, step-grandchild, stepsister, stepbrother,

mother-in-law, father-in-law, brother-in-law, sister-in-law, son-in-law, daughter-in-law, guardian,

former guardian, domestic partner, the half-brother or half-sister of a person's spouse, or the spouse

of a person's half-brother or half-sister.

The immediate family member must provide the name of the deceased voter and the date and place of death. The immediate family member must sign and date the form.

Once the voter has been cancelled in CVR, please complete the REGISTRAR USE ONLY section of the card, attach the form to the front the original source documentation (pulled voter registration card or cards) for the voter and retain for 2 years.

A supply of the new 4’ x 6” cardstock form will be mailed to each municipality as soon as they are printed. The form is also posted electronically on the Elections Temp site:



The other existing approved confirmed sources to cancel a deceased voter are still in effect:

• Vital Records

1. Vital record search by municipal clerk or registrar

2. Vital record reminders in CVR – municipal clerk or registrar confirms vital record matches voter

• Published Obituary

A published obituary, either a hard copy (i.e. newspaper) or electronic version on-line, may be

used if it contains the name of the registered voter along with the date and place of death of the

voter. The voter’s full name and date of birth should be confirmed in the obituary to ensure that

the correct voter is cancelled.

Continued on reverse

NEW Immediate Family Member Notice of Voter’s Death Form

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Department of the Secretary of State

Bureau of Corporations, Elections and Commissions

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Shenna Bellows

Secretary of State

Julie L. Flynn

Deputy Secretary of State

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