County of San Benito Clerk, Auditor & Recorder

Request for Voter Registration Information

Application for Voter Registration Information

(California Code of Regulations §19006; Elections Code §§2184, 2188,2194;
Government Code §26831, 26854, 81008)

Fee Schedule & Request for Services

Voter Information on CD / e-Mail / FTP
Fee: $40.00 per delivery     Code: GC 26831

If you are a candidate without a committee, enter "Self". If you are a committee, enter the committee name
Residence Address *

Business Address * (only if different from Residence Address)

Drivers License or State Identification Card *
* Photocopy of Identification required
Voter Information Intent and Request
Intended Use of Voter Registration Information

Additional Information
Method of Delivery

Is this application on behalf of a person other than the applicant?   
Application Certification of Truth and Correctness
       The above-named applicant/agency, hereby applies to the Department of Elections of the County of San Benito and agrees that the aforementioned information set forth in affidavits of registration of voters and any information derived from said tabulating cards, electronic data processing tapes and indices (hereinafter collectively referred to as “registration information”_ will be used only for the election or governmental purposes, as defined by Title 2, Division 7, Article 1, Section 19003 of the California Administrative Code.
       The applicant/agency, further agrees not to sell, lease, loan or deliver possession of the registration information, or a copy thereof, or any portion thereof, to any person, organization or agency without receiving written authorization to do so from the Department of Elections.
       Subject to provisions of Title 2, Division 7, Article 1, Sections 19001 through 19007 of the California Administrative Code, the applicant agrees to pay the Department of Elections, as compensation for any unauthorized use of each individual’s registration information, an amount equal to the sum of 50¢ multiplied by the number of times each registration record is used by the applicant in an unauthorized manner.
       I, certify, under penalty of perjury, that all information on this form is true and correct.
(Check to certify acceptance of the certification.)

DISCLAIMER: The Information contained herein was believed to be valid at the time of publication. The San Benito County Clerk - Auditor - Recorder - Registrar of Voters reserves the right to make changes in the website at any time and without notice. San Benito County Registrar of Voters assumes no liability for damages incurred directly or indirectly as a result of errors, omissions or discrepancies. This website is for informational purposes only and separate from the County of San Benito website. This website includes links to other websites not controlled by the San Benito County Clerk - Auditor - Recorder - Registrar of Voters. The San Benito County Clerk - Auditor - Recorder - Registrar of Voters takes no responsibility for the views, content or accuracy of the other sites, nor does it endorse any content or products contained therein.