MICHIGAN VOTER REGISTRATION APPLICATION
MICHIGAN DRIVER LICENSE/PERSONAL IDENTIFICATION CARD ADDRESS CHANGE FORM
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.
ARE YOU A U.S. CITIZEN? ppYES pp NO IF “NO,” YOU CANNOT REGISTER TO VOTE.
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
MI
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
_________/_________/_________
Sex
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.
X_________________________________________/________
Signature of Applicant Date
Registered under name of (if different than above)
Previous Street Address State Zip Code
X_________________________________________/________
Signature of Applicant Date
o City Name of City or Township County
o Township X_________________________________________/________
Signature of Applicant Date
TO REGISTER TO VOTE YOU MUST BE:
• 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
SPECIAL INSTRUCTIONS:
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
township.
NOTICE REGARDING YOUR RESIDENCE ADDRESS:
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.
MAILING INSTRUCTIONS:
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.)
Enter information on
screen and print out.
