This application may be used to 1.) register to vote or 2.) record a name or address change. To use this form, you must print
it on plain paper and complete all required entries. After completing all required entries, sign and date the form in the three
spaces marked “X.” Instructions for mailing the form appear below.
Last Name First Name Middle Name This space for office use only
Address where you live - house number and street or road Apt. No./Lot No. Name of city or township where you live
o City o Township of
City Zip Code
Name of county where you live
If no house number or street address - describe location where you live - cross streets or roads, landmarks, etc.
Mailing Address if different from above o For use on Voter Registration Only o For use on Driver License/Personal ID and Voter Registration
Date of Birth
o M o F
Voter Declaration - Read and Sign Below. I certify that:
- I am a citizen of the United States.
- I am a resident of the State of Michigan and will be at least a 30 day
resident of my city or township by election day.
Michigan Driver License Number or Personal ID Number
- I will be at least 18 years of age by election day.
- I authorize cancellation of any previous registration.
Telephone Number (optional)
( )
School District (if known)
- The information I have provided is true to the best of my knowledge under
penalty of perjury. If I have provided false information, I may be subject
to a fine or imprisonment or both under federal or state laws.
Previous Address
Are you still registered to vote at your last address? oYes o No
o Don’t Know
If you checked YES or DON’T KNOW, enter your last address below.
Signature of Applicant Date
Registered under name of (if different than above)
Previous Street Address State Zip Code
Signature of Applicant Date
o City Name of City or Township County
o Township X_________________________________________/________
Signature of Applicant Date
A United States citizen
At least 18 years of age (by election day)
A resident of Michigan and the city or township where you are
applying to register to vote
Not confined in jail after being convicted and sentenced
Every person residing in Michigan lives in either a city or a
township. If you do not know the name of your city or township,
please describe your location in the space provided for “If no house
number or street address.” Providing cross streets/ roads and
landmarks will help the clerk correctly identify your city or
Michigan law requires that the same address be used for voter
registration and driver license purposes. Therefore, if the residence
address you provide on this form differs from the address shown on
a driver license or personal identification card issued by the State of
Michigan, the Secretary of State will automatically change your
driver license or personal identification card address to match the
residence address entered on this form. If an address change is
made, the Secretary of State will mail you an address update sticker
for your driver license or personal identification card.
If you live within the city limits of one of the cities listed below, mail
the application directly to the clerk of that city. If you do not live
within one of the cities listed below but you know or can locate the
address of your city or township clerk, mail application directly to
that clerk. Otherwise, mail the application to your county clerk. The
county clerk will forward it to your city or township clerk.
Completed applications must be received or postmarked by the
close of registration for an election in order to be effective for that
election. (See below for addresses.)
Clear Form
Enter information on
screen and print out.
Your application is not valid until accepted by the clerk of the city or township in which you reside. If you do not receive a Voter I.D. card
within three weeks, contact your clerk.
Ann Arbor PO Box 8647 Ann Arbor 48107-8647 Livonia 33000 Civic Center Dr Livonia 48154-3097
Battle Creek 10 N. Division Battle Creek 49014-1717 Pontiac 450 Wide Track Dr E Pontiac 48342-2271
Bay City 301 Washington Ave Bay City 48708-5866 Roseville 29777 Gratiot Roseville 48066-0290
Dearborn 13615 Michigan Ave Dearborn 48126-3586 Royal Oak PO Box 64 Royal Oak 48068-0064
Dearborn Hts 6045 Fenton Dearborn Heights 48127-3294 Saginaw 1315 S Washington Saginaw 48601-2599
Detroit 2978 W Grand Blvd Detroit 48202-3069 St. Clair Shores 27600 Jefferson Cr. Dr St Clair Shores 48081-9971
East Lansing 410 Abbott Rd E Lansing 48823-3388 Southfield PO Box 2055 Southfield 48037-2055
Farmington Hills 31555 Eleven Mile Rd Farmington Hills 48336-1165 Sterling Heights PO Box 8009 Sterling Heights 48311-8009
Flint 1101 S Saginaw Flint 48502-1416 Taylor 23555 Goddard Taylor 48180-4117
Grand Rapids 300 Monroe Ave NW Grand Rapids 49503-2281 Troy 500 W Big Beaver Troy 48084-5285
Kalamazoo 241 W South St Kalamazoo 49007-4796 Warren 29500 Van Dyke Ave Warren 48093-6726
Lansing 124 W Michigan Lansing 48933-1694 Westland 36601 Ford Rd Westland 48185-2298
Lincoln Park 1355 Southfield Rd Lincoln Park 48146-2380 Wyoming PO Box 905 Wyoming 49509-0905
Alcona P O Box 308 Harrisville 48740-0308 Lake P O Drawer B Baldwin 49304-0902
Alger 101 Court St Munising 49862-1196 Lapeer 255 Clay St Lapeer 48446-2298
Allegan 113 Chestnut St Allegan 49010-1350 Leelanau P O Box 467 Leland 49654-0467
Alpena 720 Chisholm St Alpena 49707-2488 Lenawee 425 N Main St Adrian 49221-2198
Antrim 205 E Cayuga Bellaire 49615-0520 Livingston 200 E Grand River Howell 48843-2399
Arenac P O Box 747 Standish 48658-0747 Luce E Court St Newberry 49868-1299
Baraga 16 N 3rd St L'anse 49946-1085 Mackinac 100 N Marley St St Ignace 49781-1491
Barry 220 W State St Hastings 49058-0220 Macomb 40 N Main St Mt Clemens 48043-5661
Bay 515 Center St Bay City 48708-5994 Manistee 415 3rd St Manistee 49660-1606
Benzie P O Box 398 Beulah 49617-0398 Marquette 232 Baraga Ave Marquette 49855-4782
Berrien 811 Port St St Joseph 49085-1198 Mason 304 E Ludington Ave Ludington 49431-2121
Branch 31 Division St Coldwater 49036-1990 Mecosta 400 Elm St Big Rapids 49307-1849
Calhoun 315 W Green St Marshall 49068-1585 Menominee 839 10th Ave Menominee 49858-3000
Cass P O Box 355 Cassopolis 49031-0355 Midland 220 W Ellsworth St Midland 48640-5194
Charlevoix 203 Antrim St Charlevoix 49720-1397 Missaukee P O Box 800 Lake City 49651-0800
Cheboygan P O Box 70 Cheboygan 49721-0070 Monroe 106 E 1st St Monroe 48161-2185
Chippewa 319 Court St Sault Ste Marie 49783-2194 Montcalm P O Box 368 Stanton 48888-0368
Clare P O Box 438 Harrison 48625-0438 Montmorency P O Box 415 Atlanta 49709-0415
Clinton P O Box 69 St Johns 48879-0069 Muskegon 990 Terrace Muskegon 49442-3378
Crawford 200 W Michigan Grayling 49738-1798 Newaygo P O Box 885 White Cloud 49349-0885
Delta 310 Ludington St Escanaba 49829-4057 Oakland 1200 N Telegraph Pontiac 48341-0413
Dickinson P O Box 609 Iron Mountain 49801-0609 Oceana P O Drawer 653 Hart 49420-0653
Eaton 1045 Independence Blvd Charlotte 48813-1095 Ogemaw 806 W Houghton Ave West Branch 48661-1215
Emmet 200 Division St Petoskey 49770-2444 Ontonagon 725 Greenland Rd Ontonagon 49953-1492
Genesee 900 S Saginaw Flint 48502-1571 Osceola 301 W Upton Reed City 49677-1149
Gladwin 401 W Cedar Ave Gladwin 49624-2088 Oscoda P O Box 399 Mio 48647-0399
Gogebic 200 N Moore Bessemer 49911-1052 Otsego 225 W Main St Gaylord 49735-1393
Grand Traverse 400 Boardman Ave Traverse City 49684-2577 Ottawa 414 Washington Grand Haven 49417-1494
Gratiot P O Drawer 437 Ithaca 48847-0437 Presque Isle P O Box 110 Rogers City 49779-0110
Hillsdale 29 N Howell St Hillsdale 49242-1698 Roscommon P O Box 98 Roscommon 48653-0098
Houghton 401 E Houghton Ave Houghton 49931-2099 Saginaw 111 S Michigan Saginaw 48602-2086
Huron 250 E Huron Ave Bad Axe 48413-1386 Sanilac 60 W Sanilac Sandusky 48471-1094
Ingham P 0 Box 179 Mason 48854-0179 Schoolcraft 300 Walnut Manistique 49854-1487
Ionia 100 Main St Ionia 48846-1697 Shiawassee 208 N Shiawassee Corunna 48817-1491
Iosco P O Box 838 Tawas City 48764-0838 St Clair 201 McMorran Blvd Port Huron 48060-4082
Iron 2 S 6th St Crystal Falls 49920-1495 St Joseph P O Box 189 Centreville 49032-0189
Isabella 200 N Main St Mt Pleasant 48858-2393 Tuscola 440 N State St Caro 48723-1592
Jackson 312 S Jackson St Jackson 49201-2220 Van Buren 212 E Paw Paw Paw Paw 49079-1496
Kalamazoo 201 W Kalamazoo Ave Kalamazoo 49007-3777 Washtenaw P O Box 8645 Ann Arbor 48107-8645
Kalkaska P O Box 10 Kalkaska 49646-0010 Wayne 211 City County Bldg Detroit 48226-3463
Kent 300 Monroe NW Grand Rapids 49503-2288 Wexford 437 E Division Cadillac 49601-1905
Keweenaw 4th St Eagle River 49924-0007