/ / / /
Michigan driver’s license number or state ID number
License/ID expiration date
Are you a citizen of the United States of America?
YES
NO
Will you be 18 years of age on or before election day?
YES
NO
Male
Female
MICHIGAN CHANGE OF ADDRESS/VOTER REGISTRATION
See instructions below
Residence address
(Must be included): (Check here if this is a new address.)
Mailing address (if different):
(Check here if this is a new mailing address.)
Street and number, or R.R. and Box Number
Street and number, P.O Box, or R.R. and Box Number
, MI
, MI
City ZIP County
* Forms without a signature will not be processed.
To register to vote in Michigan you must be:
City ZIP
(Check here to remove current mailing address on file.)
• A Michigan resident (at the time you register) and a resident of your city or
township for at least 30 days (when you vote).
• A United States citizen.
• At least 18 years of age (when you vote).
• Not currently serving a sentence in jail or prison.
We will register you to vote unless you check the box below.
Don’t use my information for voter registration.
I hereby certify, under penalty of perjury, that the information contained on this application is true
and correct, and that a court is not holding my license. I understand that if I have provided false
information to apply to register to vote, I may be subject to federal or state criminal penalties.
We won’t share your
driver’s license and social
security number, day and
month of birth, email, phone
number (or decision to
not register). Some voter
registration information,
however, is public.
Applicant, sign here
Today's date
Notice: Michigan law requires that the same address be used for voter registration and driver’s license purposes. Therefore, if the
residence address you provide in the application differs from your voter registration address as it appears on the Qualified Voter
File, the Secretary of State will automatically change your registration to match the residence address on this application, after
which your voter registration at your former address will no longer be valid for voting purposes. A new voter information card, containing
the information of your polling place, will be provided to you by the clerk of the jurisdiction where your residence is located.
If you check the opt out box on this form to decline voter registration, your decision will remain confidential and will only be used for voter
registration purposes.
If you are already registered, checking the box won’t cancel your registration or stop your
registration address from being updated.
After completing the form, return it by mail to:
Michigan Department of State
P.O. Box 30764
Lansing, MI 48909-8264
If changing your driver’s license or ID card address, an address label for the back of your license or ID card will be mailed to
you within 14 days. If registering to vote, your voter registration won’t be valid until accepted by your local clerk. If your voter
identification card doesn’t arrive within 3 weeks, contact your city or township clerk.
When changing your address by mail, a letter verifying the change and containing the new address will be mailed to your old address. If
you don’t want residents at your old address to have your new address, then you should change your address in person at a Secretary of
State office.
ED-109W (02/20)
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