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State of Michigan Voter Registration Application

To change your name and address on the voter registration in the State of Michigan, you can use the State of Michigan Voter Registration Application form.

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State of Michigan Voter Registration Application   
and Michigan Driver License/Personal Identification Card Address Change Form  Instructions	 	
Track your registration status, find your local clerk, view your polling location, and more at mi.gov/vote.  	
1 	
 
 
 qualifications	 	
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.  
 	
 residential & mailing address	 	
A residential address must be provided.  If 
you do not have a residential address, 
please provide cross streets or a landmark 
in the address field describing your 
location. 
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 (ex. PO Box), you may provide a 
mailing address where indicated on the 
form.  If you provide a mailing address, it 
will not appear on your voter ID  card or 
driver license/personal identification card.  
 	
 deliver 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 the application directly to the 
clerk of that city.  If you do not live within 
one of the listed cities, you can locate the 
address of your city or township clerk by 
visiting mi.gov/vote and clicking on “Find 
Your Clerk ”. You may mail the application 
directly to that clerk.  Otherwise, mail the 
application to your county clerk (addresses 
listed on the reverse side of this sheet.)  
The county clerk will forward it to your city 
or township clerk.  
 	
registering by mail 	– special requirements for first time voters	 	
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 two requirements:  a Michigan requirement 
and a federal requirement, as explained below. 	
 	
Michigan 	requirement 	– vote in 	person	 	
 
You  must appear in person to vote in the first election in which you 
wish to participate.   This requirement does not  apply if you: (1) 
personally hand deliver this form to your county, city or township 
clerk’s office instead of mailing the form, (2) are 60 years of age or 
older, (3) are disabled, or (4) are eligible to vote under the federal 
Uniformed and Overseas Citizens Absentee Voting Act. 
federal 	requirement 	– provide	 identification	 	
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 ID DOCUMENTS BY MAIL***  
If you are subject to  this requirement and do not provide the 
information identified above, an acceptable form of identification 
must be provided before you vote in the first election in which you 
wish to participate.  
Note:  The identification requirement does not  apply if you:  (1) 
personally hand deliver this form to your county, city or township 
clerk’s office instead of mailing this form, (2) are disabled, or (3) are 
eligible to vote under the  federal  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 ( 7-15)

2 M ail your application directly to your city or township clerk.    If you do not live 
within one of the listed cities ,   you can locate the address of your city or   
township  clerk by visiting mi.gov/vote and click ing on  “Find Your Clerk.”  
Otherwise, mail this f orm 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  
Battle Creek    10 N Division St ,   Rm 111, Battle Creek 49014  
Bay City    301 Washington Ave, Bay City 48708  
Dearborn    1 6901   Michigan Ave ,   S te   11 , Dearborn 48126  
Detroit    2978 W Grand Blvd, Detroit 48202  
Dearborn Heights    6045 Fenton, Dearborn Heights 48127  
East Lansing    410 Abbott Rd, E ast   Lansing 48823  
Farmington Hills   31555   Eleven Mile Rd ,   Farmington Hills 48336  
Flint    1101 S Saginaw, Flint 48502  
Grand Rapids    300 Monroe Ave NW ,   Grand Rapids 49503  
Hamtra m ck  3401 Evaline St, Hamtra m ck 48212  
Kalamazoo    241 W South St, Kalamazoo 49007  
Lansing    124 W Michigan   Ave , Lansing 48933  
Lincoln Park    1355 Southfield Rd, Lincoln Park 48146  
Livonia    33000 Civic Center Dr, Livonia   48154  
Pontiac    47450 Woodward   Ave , Pontiac   48342  
Romulus    11111 Wayne Rd, Romulus, MI 48174  
Roseville    PO Box 290 , Rosevill e   48066  
Royal Oak    211 Williams St, Roya l Oak   48067  
Saginaw    1315 S Washington, Saginaw 48601  
S aint  Clair Shores    27600 Jefferson C ircle   Dr, S aint   Clair Shores 48081  
Southfield    2600 0   Evergreen Rd, PO  B ox 2055 , Southfield  48037  
Sterling Heights     40555 Utica Rd,  PO Box 8009, Sterling Heights 4831 1  
T aylor    23555 Goddard, Taylor 48180  
Troy    500 W Big Beaver, Troy 48084  
Warren    One City Square ,  Ste 205, Warren 48093  
Westland    36300 Warren Rd , Westland   48185  
Wyoming   1155 28 th
  St SW, Wyoming   49509  
 
County Clerks’ Addresses  
Use if you cannot locate your   city or township clerk  
Alcona   106 5 th
  St,  P O Box 308, Harrisville 48740  
Alger    101 Court St,  PO Box 538,  Munising 49862  
Allegan   113 Chestnut St , Allegan   49010  
Alpena    720  W  Chisholm St , Alpena   49707  
Antrim   PO   Box 520 , Bellaire   49615  
Arenac    120 N Grove ,  PO Box 747 , Standish   48658  
Baraga   2 S Main St , L a nse   49946  
Barry    220 W   State St , Hastings 49058  
Bay   515 Center St ,   Ste 101,  Bay City 48708  
Benzie    448 Court Pl , Beulah 49617  
Berrien    811 Port St , S aint   Joseph 49085  
Branch    31 Division St, Coldwater 49 036  
Calhoun    315 W Green St, Marshall 49068  
Cass    120 N Broadway , Cassopolis 49031  
Charlevoix    203 Antrim St, Charlevoix 49720  
Cheboygan    870 W Main St,  PO Box 70, Cheboygan 49721  
Chippewa    319 Court St, Sault S ainte   Marie 49783  
Clare    225 W Main St , P O Bo x 438, Harrison 48625  
Clinton   100 E State St ,   S t e 2600, S ain t Johns 48879  
Crawford    200 W   Michigan , Grayling   49738  
Delta    310 Ludington St, Escanaba 49829  
Dickinson    705 S Stephenson, P O Box 609, Iron Mountain 49801  
Eaton    1045 Independence Blvd ,   Charlott e 48813  
Emmet    200 Division St, Petoskey 49770   Genesee
  900 S Saginaw St, Flint 48502  Gladwin    401 W Cedar Ave, Gladwin 4 8 624  
Gogebic   200 N Moore, Bessemer   49911  
Grand Traverse    400 Boardman Ave, Traverse City 49684  
Gratiot    214 E   Center ,   Ste 16 , Ithaca 4 8847   
Hillsdale   29 N Howell St, Hillsdale 49242  
Houghton    401 E Houghton Ave, Houghton 49931  
Huron    250 E Huron Ave , Bad Axe   48413  
Ingham    PO Box 179 , Mason   48854  
Ionia    100  W  Main St, Ionia 48846  
Iosco    PO   Box 838, Tawas City 48764  
Iron    2 S 6th St, Crys tal Falls 49920  
Isabella    200 N Main St, M oun t Pleasant 48858   
Jackson    312 S   Jackson St, Jackson 49201  
Kalamazoo   201 W Kalamazoo Ave, Kalamazoo 49007  
Kalkaska    605 N Birch St, Kalkaska 49646  
Kent    300 Monroe NW, Grand Rapids 49503  
Keweenaw    5095 4th St,  Eagle River 49950  
Lake  800 Tenth St ,  Ste 200, Baldwin 49304  
Lapeer    255 Clay St, Lapeer 48446  
Leelanau    8527 E Government C en t e r Dr ,   Ste 103 ,  Suttons Bay   49 68 2  
Lenawee    425 N Main St, Adrian 49221  
Livingston    200 E Grand River, Howell 48843  
Luce    407 W Har rie St, Newberry 49868    
Mackinac    100 S Marley St ,   Rm 10, S ain t Ignace 49781  
Macomb    40 N Main St, M oun t Clemens 48043  
Manistee    415 3rd St, Manistee 49660  
Marquette   234 W Baraga Ave ,   Marquette 49855  
Mason    304 E Ludington Ave , Ludington   49431  
Mecosta    40 0 Elm St , Big Rapids   49307  
Menominee    839 10th Ave , Menominee   49858  
Midland    220 W Ellsworth St, Midland 48640  
Missaukee    111 S Canal St,  PO Box 800, Lake City 49651  
Monroe    106 E 1 s t   St , Monroe   48161  
Montcalm    211 W Main St,  PO Box 368, Stanton 48888  
Mont morency   12265 M - 32,   PO Box 789, Atlanta 49709  
Muskegon    990 Terrace   St , Muskegon 49442  
Newaygo    1087 Newell ,   PO Box 885, White Cloud 49349  
Oakland   1200 N Telegraph Bldg 12E, Pontiac   48341  
Oceana   100 State St ,   Ste 1 , Hart   49420  
Ogemaw    806 W Houghton Ave , West Branch 48661  
Ontonagon    725 Greenland Rd , Ontonagon   49953  
Osceola    301 W Upton, Reed City 49677  
Oscoda    311 Morenci Ave,  PO Box 399 , Mio   48647  
Otsego    225 W Main St, Gaylord 49735  
Ottawa    12220 Fillmore St ,   Rm 130 ,   West Olive 49460  
Presque Isle    PO  Box 110, Rogers   City   49779  
Roscommon    500 Lake St, Roscommon 48653  
Saginaw    111 S Michigan, Saginaw 48602  
Sanilac    60 W Sanilac, Sandusky 48471  
Schoolcraft   300 Walnut, Manistique 49854  
Shiawassee    208 N Shiawassee, Corunna 48817  
S ain t Clair   201 McMorran B lvd, Port Huron 48060  
S ain t Joseph    125 W Main St,  PO Box 189 , Centreville   49032  
Tuscola    440 N   State St , Caro   48723  
Van Buren    212   E  Paw Paw, Paw Paw   49079  
Washtenaw    200 N Main St, Ann Arbor   4810 4  
Wayne    2 Woodward Ave ,   Rm 502, Detroit 48226  
Wexford    437   E   Division   St , Cadillac  49601

instructions	 	
 
Already registered in Michigan?  
Update your address quickly and 
easily at ExpressSOS.com.  
 
 
Complete this form to register to 
vote or update your registration 
information	1. 	
 
 	
Please print all information 
clearly using black or blue 
pen. 
 
Sign the form.  
 
Mail or deliver this form to 
your city/township  clerk.  	
 
 
Locate your local clerk  or obtain 
more information  at mi.gov/vote.  
 
 1Name changes must be completed 
at an SOS branch office.  
 
 	
This registration will be in 
effect for the next election 
if postmarked or delivered 
no later than 30 days 
before election  day  and 
you have met all the 
qualifications  to register to 
vote.  
 	
If a voter possesses a Michigan 
driver license (DL) or personal ID 
(PID),  Michigan law requires the 
same address be used for voter 
registration and DL/PI D purposes .  
Use of this form will also change 
your DL/PI D address.  The Secretary 
of State will mail you a  new  address 
sticker for you r DL/PID. 
 
 
If you have never voted  in  person in 
Michigan and choose to submit this 
form by mail, review the 
instructions on page 1 .  Additional 
requirements apply. 
 
 
More instructions can be found on 
page 1.  	
State of Michigan Voter Registration Application  
and Michigan Driver License/Personal Identification Card Address Change Form	 
 	
qualifications	 
Are you a citizen of the United States of America?	 	 yes	 	 no	 	
Will you be 	at least 	18 years of age on or before election day?	 	 yes	 	 no	 	 	
If you 	are not a US 	citizen	, do NOT complete this form	 	
Michigan driver license/state	 personal	 ID #	 	
 	
-                       -                         -                        - 
 	
I f you do not have a Michigan driver license or  personal ID card, provide the last four 
digits of your Social Security number: 
 
x x x –  x x –   
 
 I do not have a valid Michigan issued driver license, a Michigan personal ID card, or a 
Social Security number.	
 	 
personal information	    *required 	information	 	
 	 	 	 	
last name*	 	first*	 	middle	 	suffix	 	
 	 	  male     female 	
address where you live 	– house number and street/road*     	                 	       apt/lot #	 	
 /       /	 	
 
 	 	
city	* 	zip 	        	date of birth*	 	
 	 	 	 	
phone	 	email	 	 	 	
 	 	 	 	
mailing address	 (if different than residential address)	 	  	 	 	 	
city	 	state	 	zip 	 	
signature	 	
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 the 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                                                                                                                    	                      	date	 	
former registration	 	
If you 	were previously	 registered 	outside of M	I and/	or with a different name	, complete	 	
this section	. 	
  	 	 	 	
previous registration name	 	previous county	 	
 	 	 	 	
previous address	 	previous state
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