TO REGISTER TO VOTE IN MICHIGAN YOU MUST BE:

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1 Michigan Voter Registration Application and Michigan Driver License/Personal Identification Card Address Change Form -- Instructions and Special Notices -- 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. YOU CAN USE THIS FORM TO: Register to vote in Michigan. Change your name or address on your voter registration NOTICE: VOTER REGISTRATION ADDRESS AND DRIVER LICENSE ADDRESS MUST BE THE SAME. 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.

2 IDENTIFYING YOUR CITY OR TOWNSHIP OF RESIDENCE: 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. MAIL OR HAND DELIVER THIS FORM TO YOUR CITY OR TOWNSHIP CLERK. MAILING INSTRUCTIONS: If you live within the city limits of one of the cities listed in this packet, mail 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, address and mail application directly to that clerk. Otherwise, mail the application to your county clerk (The addresses of Michigan s 83 county clerks are also listed in this packet.) 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. IDENTIFICATION REQUIREMENT FOR NEW MICHIGAN REGISTRANTS: If you have never voted in Michigan and choose to submit this form by mail, place this form in an envelope and enclose one of the following forms of identification: (1) COPY of a current and valid photo identification (such as a driver license or personal ID card) or (2) COPY of a paycheck stub, utility bill, bank statement or a government document which lists your name and address. DO NOT SEND ORIGINAL ID DOCUMENTS BY MAIL. If identification is needed but not provided with this form, an acceptable form of identification will be requested before you vote at the next federal election. The submission of an acceptable form of identification is not required if (1) you are updating your voter registration to show a move within the state (2) you submit this form in person or (3) another individual personally submits this form on your behalf.

3 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, contact your clerk.

4 Send this form to your city or township clerk. Addresses for selected cities are provided below. You must live within the city limits to use a city clerk s address. If you do not know the address of your city or township clerk, mail this form to your county clerk. Addresses for Michigan s 83 county clerks appear below. SELECTED CITY CLERKS ADDRESSES Ann Arbor PO Box 8647, Ann Arbor, Battle Creek Bay City Dearborn Detroit Dearborn Heights East Lansing Farmington Hills Flint Grand Rapids 10 N. Division St. Room 111, Battle Creek, Washington Ave., Bay City, Michigan Ave., Dearborn, W. Grand Blvd., Detroit Fenton, Dearborn Heights, Abbott Rd., E. Lansing, Eleven Mile Rd., Farmington Hills, S. Saginaw, Flint, Monroe Ave., NW Grand Rapids, Livonia Pontiac Roseville Royal Oak Saginaw St. Clair Shores Civic Center Dr., Livonia, Woodward, Pontiac, Gratiot, Roseville, P.O. Box 64, Royal Oak, S. Washington, Saginaw Jefferson Cr. Dr., St. Clair Shores, Southfield P.O. Box 2055, Southfield, Sterling Heights Taylor Troy P.O. Box 8009, Sterling Heights, Goddard, Taylor, W. Big Beaver, Troy,

5 Kalamazoo 241 W. South St., Kalamazoo, Lansing Lincoln Park 124 W. Michigan, Lansing Southfield Rd., Lincoln Park, Warren One City Square Suite 205., Warren, Westland Ford Rd., Westland, Wyoming P.O. Box 905, Wyoming, COUNTY CLERKS ADDRESSES Alcona P. O. Box 308, Harrisville, Alger 101 Court St., Munising, Allegan 113 Chestnut St., Allegan, Alpena 720 Chisholm St., Alpena, Antrim P.O. Box 520, Bellaire, Arenac P.O. Box 747, Standish, Baraga Barry Bay 16 N. 3rd St., L'anse, W. State St., Hastings, Center St., Bay City, Lake 800 Tenth St. - Suite 200, Baldwin, Lapeer 255 Clay St., Lapeer, Leelanau P.O. Box 467, Leland, Lenawee 425 N. Main St., Adrian, Livingston 200 E. Grand River, Howell, Luce 407 W. Harrie St., Newberry, Mackinac 100 S. Marley St. Room 10, St. Ignace, Macomb 40 N. Main St., Mt Clemens, Manistee 415 3rd St., Manistee,

6 Benzie Berrien Branch Calhoun 448 Court Place, Beulah, Port St., St. Joseph, Division St., Coldwater, W. Green St., Marshall, Cass P.O. Box 355, Cassopolis, Charlevoix 203 Antrim St., Charlevoix, Cheboygan P.O. Box 70, Cheboygan, Chippewa 319 Court St., Sault Ste Marie, Clare P.O. Box 438, Harrison, Clinton Crawford Delta 100 E. State St. Ste 2600, St. Johns, W. Michigan, Grayling, Ludington St., Escanaba Marquette Mason Mecosta Menominee Midland Missaukee Monroe 234 W. Baraga Ave., Marquette, E. Ludington Ave., Ludington, Elm St., Big Rapids, th Ave., Menominee, W. Ellsworth St., Midland, P.O. Box 800, Lake City, E. 1St. St., Monroe, Montcalm P.O. Box 368, Stanton, Montmorenc y Muskegon Newaygo Oakland P.O. Box 789, Atlanta, Terrace, Muskegon, P.O. Box 885, White Cloud, N. Telegraph, Pontiac,

7 Dickinson Eaton Emmet Genesee Gladwin Gogebic Grand Traverse Gratiot Hillsdale Houghton Huron Ingham P.O. Box 609, Iron Mountain, Independence Blvd., Charlotte, Division St., Petoskey, S. Saginaw, Flint W. Cedar Ave., Gladwin, N. Moore, Bessemer, Boardman Ave., Traverse City, E. Gratiot, Suite 16, Ithaca, N. Howell St., Hillsdale, E. Houghton Ave., Houghton, E. Huron Ave., Bad Axe, P.O. Box 179, Mason, Oceana Ogemaw Ontonagon Osceola Oscoda Otsego Ottawa 100 State St., Suite 1, Hart, W. Houghton Ave., West Branch, Greenland Rd., Ontonagon, W. Upton, Reed City, P.O. Box 399, Mio, W. Main St., Gaylord, Washington, Grand Haven, Presque Isle P.O. Box 110, Rogers City, Roscommon 500 Lake St., Roscommon, Saginaw Sanilac 111 S. Michigan, Saginaw, W. Sanilac, Sandusky,

8 Ionia Iosco Iron Isabella 100 Main St., Ionia, P.O. Box 838, Tawas City, S 6th St., Crystal Falls, N. Main St., Mt Pleasant, Jackson 312 S. Jackson St., Jackson, Kalamazoo 201 W. Kalamazoo Ave., Kalamazoo, Kalkaska 605 N. Birch St., Kalkaska, Kent 300 Monroe NW., Grand Rapids, Keweenaw th St., Eagle River, Schoolcraft 300 Walnut, Manistique, Shiawassee 208 N. Shiawassee, Corunna St. Clair 201 McMorran Blvd., Port Huron, St. Joseph P.O. Box 189, Centreville, Tuscola 440 N. State St., Caro, Van Buren 212 Paw Paw, Paw Paw, Washtenaw Wayne Wexford P.O. Box 8645, Ann Arbor, Woodward Ave, Room 502, Detroit, E. Division, Cadillac,

9 Michigan Voter Registration Application and Michigan Driver License/Personal Identification Card Address Change Form After completing application, sign and date in three spaces marked X. Additional signatures will be used for school or village records. BEFORE MAILING, REMOVE TAPE FROM OPPOSITE END OF FORM AND FOLD IN HALF TO SEAL CLOSED HERE. ANSWER FIRST Are you a citizen of the United States of America? Yes Will you be 18 years of age on or before election day? Yes No If you checked No in response to either of these questions, do not complete this form. No Last Name First Name Middle Name Address where you live - house number and street or road Apt. No./Lot No. Name of city or township where you live City Township of City MI 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) For use on Driver License/Personal ID and Voter Registration For use on Voter Registration Only

10 Date of Birth Sex / / M F ID Number Check applicable box and provide appropriate number. Check if you have a state issued driver license or personal ID card and enter your driver license or personal ID card number here: Check if you do not have a state issued driver license or personal ID card and enter the last four digits of your Social Security Number here: Check if you 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.) Telephone Number (optional) ( ) School District (if known) Previous Address Are you still registered to vote at your last address? Yes No Don t Know If you checked YES or DON T KNOW, enter last address below. Registered under name of (if different than above) Previous Street Address State Zip Code City Township Name of City or Township County

11 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. - I authorize cancellation of any previous registration. - 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. X / / Signature of Applicant Date X / / Signature of Applicant Date X / / Signature of Applicant Date

12 Put firstclass postage stamp here Clerk of: Address: City: County, City or Township MI Zip Code

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