Fill - Free fillable State of Michigan Voter Registration Application and Michigan (Charter Township of Waterford) PDF form

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

– 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.

(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)

Find your local clerk's office at www.michigan.gov/vote

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.

Selected City Clerks’ Addresses

You must live within the city limits to use a city clerk’s address.

Ann Arbor 301 E Huron St., Ann Arbor 48107-8647

Battle Creek 10 N. Division St. Room 111, Battle Creek 49014

Bay City 301 Washington Ave., Bay City 48708-5866

Dearborn 16901 Michigan Ave. Suite 11, Dearborn 48126-3586

Detroit 2978 W. Grand Blvd., Detroit 48202-3069

Dearborn Heights 6045 Fenton, Dearborn Heights 48127-3294

East Lansing 410 Abbott Rd., E. Lansing 48823-3388

Farmington Hills 31555 W. Eleven Mile Rd., Farmington Hills 48336-1165

Flint 1101 S. Saginaw, Flint 48502-1416

Grand Rapids 300 Monroe Ave., NW, Grand Rapids 49503-2281

Hamtramck 3401 Evaline St., Hamtramck 48212

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 48342-2271

Roseville P.O. Box 290, Roseville 48066-0290

Royal Oak 211 Williamst St., Royal Oak 48068-0064

Saginaw 1315 S. Washington, Saginaw 48601-2599

St. Clair Shores 27600 Jefferson Cr. Dr., St. Clair Shores 48081-2093

Southfield 26000 Evergreen Rd. PO Box 2055, Southfield 48076-4453

Sterling Heights 40555 Utica Rd., PO Box 8009, Sterling Heights 48311-8009

Taylor 23555 Goddard, Taylor 48180-4117

Troy 500 W. Big Beaver, Troy 48084-5285

Warren One City Square Suite 205, Warren 48093-2393

Westland 36300 Warren Rd., Westland 48185-22016

Wyoming 1155 28th St. SW, Wyoming 49509-2825

County Clerks’ Addresses

Use if you cannot locate your city or township clerk

Alcona 106 5th St., P. O. Box 308, Harrisville 48740-0308

Alger 101 Court St. PO Box 538, Munising 49862-1196

Allegan 113 Chestnut St., Allegan 49010-1350

Alpena 720 Chisholm St., Alpena 49707-2488

Antrim P.O. Box 520, Bellaire 49615-0520

Arenac 120 N Grove PO Box 747, Standish 48658-0747

Baraga 2 S Main St., L'anse 49946-1026

Barry 220 W. State St., Hastings 49058-1462

Bay 515 Center St. Suite 101, Bay City 48708-4280

Benzie 448 Court Place, Beulah 49617-9518

Berrien 811 Port St., St. Joseph 49085-1198

Branch 31 Division St., Coldwater 49036-1990

Calhoun 315 W. Green St., Marshall 49068-1585

Cass 120 N Broadway, Cassopolis 49031-0355

Charlevoix 203 Antrim St., Charlevoix 49720-1397

Cheboygan 870 S Main St. PO Box 70, Cheboygan 49721-0070

Chippewa 319 Court St., Sault Ste Marie 49783-2194

Clare 225 W Main St. PO Box 438, Harrison 48625-0438

Clinton 100 E. State St

. Ste 2600, St. Johns 48879

Crawford 200 W. Michigan, Grayling 49738-1798

Delta 310 Ludington St., Escanaba 49829-4057

Dickinson 705 S Stephenson PO Box 609, Iron Mountain 49801-0609

Eaton 1045 Independence Blvd., Charlotte 48813-1095

Emmet 200 Division St., Petoskey 49770-2444

Genesee 1101 Beach St., Flint 48502-1428

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 214 E. Center, Suite 16, Ithaca 48847-1446

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 P.O. Box 179, Mason 48854-0179

Ionia 100 Main St., Ionia 48846-1697

Iosco P.O. 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 605 N. Birch St., Kalkaska 49646-8414

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

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. Room 10, 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 49855-4782

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 111 S Canal St PO Box 800, Lake City 49651-0800

Monroe 106 E. 1st. St., Monroe 48161-2185

Montcalm 211 W Main St PO Box 368, Stanton 48888-0368

Montmorency 12265 M-32 W PO Box 789, Atlanta 49709-0789

Muskegon 990 Terrace St., Muskegon 49442-3378

Newaygo 1087 Newell PO Box 885, White Cloud 49349-0885

Oakland 1200 N. Telegraph Bldg 12E, Pontiac 48341-0413

Oceana 100 State St., Suite 1, Hart

49420

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 311 Morenci Ave. PO Box 399, Mio 48647-0399

Otsego 225 W. Main St., Gaylord 49735-1393

Ottawa 12220 Fillmore St., Room 130, West Olive 49460-8986

Presque Isle P.O. Box 110, Rogers City 49779-0110

Roscommon 500 Lake St., Roscommon 48653

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 125 W Main St PO Box 189, Centreville 49032-0189

Tuscola 440 N. State St., Caro 48723-1592

Van Buren 212 Paw Paw, Paw Paw 49079-1496

Washtenaw 200 N Main St, Ann Arbor 48104-1413

Wayne 2 Woodward Ave, Room 502, Detroit 48226-3463

Wexford 437 E. Division, Cadillac 49601-1905

Find your local clerk's office at www.michigan.gov/vote

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

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.

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.

BEFOR E MA ILING, REMO VE TAPE AND FOLD IN HALF TO SEAL CLOSED.

Clear Form

Find your local clerk's office at www.michigan.gov/vote

ED-121

Return this form to your local clerk's office. Addresses available at www.michigan.gov/vote

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State of Michigan Voter Registration Application and Michigan (Charter Township of Waterford)

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