Johnston County Elections | Notification of Deceased Voter Form

Notification of a Deceased Voter

This form is intended to provide notification of the death of a Johnston County registered voter to the Johnston County Board of Elections. Upon confirmation of the voter, the board of elections will remove the voter from the county's list of registered voters. This form may only be completed by a near relative or personal representative of the deceased voter's estate.

Complete this form as thoroughly as possible. Requested information will be used to ensure that we have the correct voter. Sign the form and then submit it to the Johnston County Board of Elections office using the button at the bottom.

Fields marked with an asterisk (*) are required.

Part 1: Deceased Voter Information

Last Name:*

First Name:*

Middle Name:

Suffix:

Date of Birth:

Age:

Gender:

Last 4 digits of SSN:

Driver License or ID No.:

Voter Registration Number:

Voter Registration Address:

Voter Registration City:

Voter Registration State:

Voter Registration County:

County Of Registration:

Date of Death:

Last Known Address:

Last Known State:

Last Known County:

County of Death:

State of Death:

Part 2: Person Providing Deceased Voter Information

Provider Full Name:*

Provider Address:*

Provider City:*

Provider State:*

Provider Zip:*

Provider Email:*

Provider Phone:* Format: xxx-xxxx (include hyphen)

Relationship to Voter (North Carolina law defines a "Near Relative" as): *

Printed Signature:*

Date Signed:*

Security Question:

Notice: In an effort to prevent Spam form submissions, you will need to type the word 'ndvoter2022' in the field below, without any quotation marks, in order to submit your form.

Page last updated: October 10, 2022