Fillable State of Michigan Voter Registration Application and Michigan (Gogebic Community College)

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State of Michigan Voter Registration Application and Michigan (Gogebic Community College)

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State of Michigan
Voter Registration Application and Michigan Driver License/
Personal Identification Card Address Change Form
1 You can use this form to:
– Register to vote in Michigan.
– Change your name or address on your voter registration.
If you have never voted in Michigan and choose to submit this form by mail,
you must appear in person to vote in the first election in which you
wish to participate. This requirement does not apply if (1) you personally
hand deliver this form to your county, city or township clerk’s office instead
of mailing the form (2) you are 60 years of age or more (3) you are disabled
or (4) you are eligible to vote under the Uniformed and Overseas Citizens
Absentee Voting Act.
2 To register to vote in Michigan you must be:
– A resident of Michigan and the city or township where you are applying to
register to vote.
– A citizen of the United States of America.
– At least 18 years of age (by election day).
– Not serving a sentence in jail or prison.
3 Voter registration and driver license address must be the same
Michigan law states that the same address must 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.
4 Identifying the city or township where you live
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 or street address. Providing cross
streets/roads and landmarks will help the clerk correctly identify your city or
township.
5 Mailing address option provided
If you would prefer to receive mail related to your voter registration or driver
license/personal identification card at an address other than your residential
address, provide a mailing address where indicated on the form. If you
provide a mailing address, it will not appear on your voter I.D. card or driver
license/personal identification card.
6 Mail or hand deliver this form to your city or township clerk
If you live within the city limits of one of the cities listed on the reverse side
of this sheet, mail or hand deliver the application directly to the clerk of that
city. If you do not live within one of the listed cities but you know or can
locate the address of your city or township clerk, mail or hand deliver the
application directly to that clerk. Otherwise, mail or hand deliver the
application to your county clerk. (The addresses of Michigan’s 83 county
clerks are also listed on the reverse side of this sheet.) 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.
Are you registering to vote in
Michigan for the first time?
If you have never voted in Michigan
and choose to submit this form by mail,
you must meet a new identification
requirement provided under federal
law. To comply with the identification
requirement, you must:
(1) accurately enter your state issued
driver license number or personal
ID card number where requested
on this form.
or
(2) send one of the following forms of
identification when mailing this form
to your county, city or township
clerk: a COPY of a current and
valid photo identification (such as a
driver license or personal ID card)
or a COPY of a paycheck stub,
utility bill, bank statement or a
government document which lists
your name and address.
DO NOT SEND ORIGINAL
DOCUMENTS BY MAIL.
If you are subject to the identification
requirement and do not meet the
requirement as explained above, an
acceptable form of identification will be
requested before you vote in the first
election in which you wish to
participate.
Note: The identification requirement
does not apply if (1) you personally
hand deliver this form to your county,
city or township clerk’s office instead of
mailing this form (2) you are disabled
or (3) you are eligible to vote under the
Uniformed and Overseas Citizens
Absentee Voting Act.
Contact your city or township clerk
if you have any questions
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 or have any questions,
contact your clerk.
ED-121 (Rev. 4-04)
County Clerks’ Addresses
Use if you cannot locate your city or township clerk
Alcona PO Box 308, Harrisville 48740-0308
Alger 101 Court St, Munising 49862-1196
Allegan 113 Chestnut St, Allegan 49010-1350
Alpena 720 Chisholm St, Alpena 49707-2488
Antrim PO Box 520, Bellaire 49615-0520
Arenac PO Box 747, Standish 48658-0747
Baraga 16 N. 3rd St, L’anse 49946-1085
Barry 220 W. State St, Hastings 49058-1462
Bay 515 Center St, Bay City 48708-5994
Benzie PO Box 377, Beulah 49617-0377
Berrien 811 Port St, St Joseph 49085-1198
Branch 31 Division St, Coldwater 49036-1990
Calhoun 315 W. Green St, Marshall 49068-1585
Cass PO Box 355, Cassopolis 49031-0355
Charlevoix 203 Antrim St, Charlevoix 49720-1397
Cheboygan PO Box 70, Cheboygan 49721-0070
Chippewa 319 Court St, Sault Ste Marie 49783-2194
Clare PO Box 438, Harrison 48625-0438
Clinton 100 E. State St., Suite 2600, St Johns 48879-1571
Crawford 200 W. Michigan, Grayling 49738-1798
Delta 310 Ludington St, Escanaba 49829-4057
Dickinson PO Box 609, Iron Mountain 49801-0609
Eaton 1045 Independence Blvd., Charlotte 48813-1095
Emmet 200 Division St, Petoskey 49770-2444
Genesee 900 S. Saginaw, Flint 48502-1571
Gladwin 401 W. Cedar Ave, Gladwin 49624-2088
Gogebic 200 N. Moore, Bessemer,49911-1052
Grand Traverse 400 Boardman Ave, Traverse City 49684-2577
Gratiot PO Drawer 437, Ithaca 48847-0437
Hillsdale 29 N. Howell St, Hillsdale 49242-1698
Houghton 401 E. Houghton Ave, Houghton 49931-2099
Huron 250 E. Huron Ave, Bad Axe 48413-1386
Ingham PO Box 179, Mason 48854-0179
Ionia 100 Main St, Ionia 48846-1697
Iosco PO Box 838, Tawas City 48764-0838
Iron 2 S 6th St, Crystal Falls 49920-1495
Isabella 200 N. Main St, Mt Pleasant 48858-2393
Jackson 312 S. Jackson St, Jackson 49201-1315
Kalamazoo 201 W. Kalamazoo Ave, Kalamazoo 49007-3777
Kalkaska PO Box 10, Kalkaska 49646-0010
Kent 300 Monroe NW, Grand Rapids 49503-2288
Keweenaw 5095 4th St, Eagle River 49950-9624
Lake 800 Tenth St, Suite 200, Baldwin 49304-7971
Lapeer 255 Clay St, Lapeer 48446-2298
Leelanau 8527 E Government Ctr Dr, Ste 103, Suttons Bay 49682-9742
Lenawee 425 N. Main St, Adrian 49221-2198
Livingston 200 E. Grand River, Howell 48843-2399
Luce 407 W. Harrie St, Newberry 49868-1299
Mackinac 100 S. Marley St, St Ignace 49781-1491
Macomb 40 N. Main St, Mt Clemens 48043-5661
Manistee 415 3rd St, Manistee 49660-1606
Marquette 234 W. Baraga Ave, Marquette 49855-4710
Mason 304 E. Ludington Ave, Ludington 49431-2121
Mecosta 400 Elm St, Big Rapids 49307-1849
Menominee 839 10th Ave, Menominee 49858-3000
Midland 220 W. Ellsworth St, Midland 48640-5194
Missaukee PO Box 800, Lake City 49651-0800
Monroe 106 E. 1St St, Monroe 48161-2185
Montcalm PO Box 368, Stanton 48888-0368
Montmorency PO Box 789, Atlanta 49709-0789
Muskegon 990 Terrace, Muskegon 49442-3378
Newaygo PO Box 885, White Cloud 49349-0885
Oakland 1200 N. Telegraph, Pontiac 48341-0413
Oceana 100 State St. Suite 1, Hart 49420-1188
Ogemaw 806 W. Houghton Ave, West Branch 48661-1215
Ontonagon 725 Greenland Rd., Ontonagon 49953-1492
Osceola 301 W. Upton, Reed City 49677-1149
Oscoda PO Box 399, Mio 48647-0399
Otsego 225 W. Main St, Gaylord 49735-1393
Ottawa 414 Washington, Grand Haven 49417-1494
Presque Isle PO Box 110, Rogers City 49779-0110
Roscommon 500 Lake St., Roscommon 48653-7664
Saginaw 111 S. Michigan, Saginaw 48602-2086
Sanilac 60 W. Sanilac, Sandusky 48471-1094
Schoolcraft 300 Walnut, Manistique 49854-1487
Shiawassee 208 N. Shiawassee, Corunna 48817-1491
St.Clair 201 McMorran Blvd, Port Huron 48060-4082
St.Joseph PO Box 189, Centreville 49032-0189
Tuscola 440 N. State St, Caro 48723-1592
Van Buren 212 E. Paw Paw Ste 101, Paw Paw 49079-1496
Washtenaw PO Box 8645, Ann Arbor 48107-8645
Wayne 2 Woodward Ave. Room 502 Detroit 48226-3463
Wexford 437 E. Division, Cadillac 49601-1905
Selected City Clerks’ Addresses
You must live within the city limits to use a city clerk’s address.
Ann Arbor PO Box 8647, Ann Arbor 48107-8647
Battle Creek 10 N.Division St, Battle Creek 49014-4004
Bay City 301 Washington Ave, Bay City 48708-5866
Dearborn 13615 Michigan Ave, Dearborn 48126-3586
Detroit 2978 W. Grand Blvd, Detroit 48202-3069
Dearborn Heights 6045 Fenton, Dearborn Heights 48127-3294
East Lansing 410 Abbott Rd, East Lansing 48823-3388
Farmington Hills 31555 Eleven Mile Rd, Farmington Hills 48336-1165
Flint 1101 S.Saginaw St, Flint 48502-1416
Grand Rapids 300 Monroe Ave NW, Grand Rapids 49503-2281
Kalamazoo 241 W. South St, Kalamazoo 49007-4796
Lansing 124 W. Michigan, Lansing 48933-1694
Lincoln Park 1355 Southfield Rd, Lincoln Park 48146-2380
Livonia 33000 Civic Center Dr, Livonia 48154-3097
Pontiac 47450 Woodward, Pontiac 48342-5021
Roseville 29777 Gratiot, Roseville 48066-0290
Royal Oak PO Box 64, Royal Oak 48068-0064
Saginaw 1315 S.Washington Ave, Saginaw 48601-2599
St.Clair Shores 27600 Jefferson Cr. Dr, St.Clair Shores 48081-2093
Southfield PO Box 2055, Southfield 48037-2055
Sterling Heights PO Box 8009, Sterling Heights 48311-8009
Taylor 23555 Goddard, Taylor 48180-4117
Troy 500 W. Big Beaver Rd, Troy 48084-5285
Warren One City Square Suite 205, Warren 48093-2393
Westland 36601 Ford Rd, Westland 48185-2298
Wyoming PO Box 905, Wyoming 49509-0905
➤
If you know or can locate the correct address,
mail your application directly to your city or township clerk.
Otherwise, mail this form to your county clerk, who will forward it.
1
State of Michigan Voter Registration Application
and Michigan Driver License/Personal Identification Card Address Change Form
a n s w e r
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
➤
If you responded No to either of these questions, do NOT complete this form.
2 complete application
Last Name First Name Middle Name
Address where you live — house number and stree t/road Apt. No./ Lot No.
City
MI
Zip Code Telephone optional
If you do not have a house or street address, describe location where you live — cross streets or roads, landmarks, etc.
❍ City or ❍ Township where you live County where you live School District if known
Mailing Address if different ❍ For use on Driver License/Personal ID and Voter Registration ❍ For use on Voter Registration only
Date of Birth ❍ Male ❍ Female
ID Number check applicable box and provide appropriate number
❍ I have a state issued driver license or personal ID card # State
❍ I do not have a state issued driver license or personal ID card. The last four digits of my Social Security Number are
❍ I do not have a state issued driver license, a state issued personal ID card or a Social Security Number.
An ID number will be assigned to you for voter registration purposes.
Are you still registered to vote at your last address? ❍ Yes ❍ No ❍ Don’t Know If “Yes” or “Don‘t Know” enter previous address
Previous Street Address ❍ City or ❍ Township of County
State Zip Code Registered under name of if different than above
3 read, sign and date
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.
– I will be at least 18 years of age by election day.
– I authorize cancellation of any previous registration.
X
Signature of Applicant Date
X
Signature of Applicant Date
– The information I have provided is true to the best
of my knowledge under penalty of perjury. If I have
Sign and date both spaces provided above.
provided false information, I may be subject to a fine
or imprisonment or both under federal or state laws.
BEFORE MAILING, REMO VE TAPE AND FOLD IN HALF TO SEAL CLOSED.
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State of Michigan Voter Registration Application and Michigan (Gogebic Community College)

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Completed 17 September 2020

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