HomeMy WebLinkAboutApplication to Remove Deceased Person from Voters' ListAPPLICATION FOR REMOVAL OF
DECEASED PERSONS NAME FROM VOTERS' LIST
Municipal Elections Act, 1996 (s.25) - City of Kitchener
APPLICANT
Surname of Applicant Given Names
Full Address of Residence
Apt. No.
Postal Code
Mailing Address if Different
Voting Subdivision No.
Assessment Roll Number (If known)
IN RESPECT OF
Name as entered on Voters' List
Qualifying Address
Apt. No.
Postal Code
Ward No.
Voting Subdivision No.
Assessment Roll Number (If known)
This information is collected under authority of s.17 and s.24 of the Municipal Elections Act and s.15 and s.16 of the Assessment Act.
STATEMENT BY APPLICANT
I, the undersigned, hereby state:
That I have good reason to believe that the person named above as entered on the Voters' List for the said voting subdivision in this municipality is
not entitled to be an elector and to have her/his name entered on the Voters' List.
(Name - Print)
(Signature of Applicant) (Date Signed)
Certificate of Approval [to be completed by Clerk or designate (i.e. DRO]
❑ Approved ❑ Refused (state reason)
I hereby certify that the Voters' List for said voting subdivision in this
municipality shall be amended in accordance with the statement of facts
or information contained herein.
Signature of Clerk or designate Date
DRO USE ONLY: DO NOT REMOVE NAME FROM VOTERS' LIST. PLACE
COMPLETED APPLICATION IN ENVELOPE "G"
Schedule. -068
Acceptable Documents Showing Proof of Death
An Application for Removal of a Deceased Persons Name from the Voters' List for City of Kitchener municipal
elections must include a document that shows proof of death. The Applicant may provide one of the following
documents to meet this requirement:
A burial or death certificate
A Medical Certificate of Death
A document /receipt issued by a cemetery/crematorium in Ontario that proves burial or cremation
A statement from a medical doctor, coroner or funeral director
A Registration of Death
A notarial copy of Letters of Probate 2
A Life or Group Insurance claim along with a statement signed by a medical doctor
An official notification from the Public Trustee
A Memorandum of Notification of Death issued by the Chief of Defence Staff of National Defence A Statement of
Verification of Death from the Department of Veterans Affairs
A program from a funeral ceremony
An obituary from a newspaper
Schedule. -068