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OUT‐OF‐STATE RESIDENT APPLICATION FOR DUPLICATE DRIVER’S LICENSE OR STATE ID AND/OR DRIVER’S LICENSE REINSTATEMENT

MICHIGAN DEPARTMENT OF STATE

PLEASE PRINT OR TYPE INFORMATION REQUESTED

1. REQUESTOR’S INFORMATION NAME AS IT APPEARS ON MICHIGAN DRIVER’S LICENSE OR STATE ID (FIRST, MIDDLE, LAST, SUFFIX) DATE OF BIRTH (MM/DD/YYYY)

DRIVER’S LICENSE OR STATE ID NUMBER DAYTIME PHONE NUMBER EXTENSION

( )

STREET ADDRESS (MICHIGAN RESIDENCE) CITY STATE

MI

ZIP

ONE‐TIME OUT‐OF‐STATE MAILING ADDRESS CITY STATE ZIP

2. DUPLICATE DRIVER’S LICENSE OR STATE ID 3. DRIVER’S LICENSE REINSTATEMENT

Duplicate Driver’s License/State ID Fees (check one):

Operator ‐ $9 Chauffeur ‐ $18 Enhanced Operator ‐ $24 Enhanced Chauffeur ‐ $33 State ID ‐ $10 Enhanced State ID ‐ $30

A hard copy of your driver’s license will take approximately 4 weeks to arrive after processing. A Temporary Operator Permit may be printed up to 60 days after your request is processed by visiting the Online Services section at Michigan.gov/SOS.

Reinstatement Fee Types (check those applicable):

Standard ‐ $125 Minor in Possession (MIP) ‐ $125 Controlled Substance ‐ $125 Watercraft ‐ $125 Snowmobile ‐ $125 Friend of the Court ‐ Compliance Certificate must accompany $85

I need a no‐fee duplicate driver’s license. Yes No

If a reinstatement fee is currently due, your current Michigan credential is not valid.

4. AUTOMATIC VOTER REGISTRATION

We will register you to vote unless you check the box below to opt out.

Are you a U.S. citizen? Yes No Don’t use my information for voter registration. To be eligible to vote, you must be a U.S. citizen, at least 18 years old (when you vote), and a 30‐day resident of your city or township in Michigan. If you’re eligible, this form will register you to vote unless you check the opt‐out box. If you’re already registered, checking the box won’t cancel your registration or stop your registration address from being updated. Some voter registration information is public, but we won’t share your driver’s license or Social Security number, day or month of birth, email, or phone number, or your decision not to register. Automatic voter registration does not apply for reinstatement only applications.

5. CERTIFICATION My signature below certifies that all statements on this application are true and correct. I certify that I am a resident of the State of Michigan. IT IS A CRIME TO MAKE A FALSE REPRESENTATION ON AN APPLICATION FOR AN OFFICIAL STATE OF MICHIGAN DRIVER’S LICENSE OR STATE ID.

__________________________________________________________________________________________________ ______________________

APPLICANT’S SIGNATURE (ADOBE SOFTWARE SIGNATURES ARE NOT ACCEPTED) DATE

6. PAYMENT METHOD PAYMENT ENCLOSED

Check

Money Order

Make payable to

“State of Michigan”

CREDIT CARD PAYMENT (A NOMINAL PROCESSING FEE MAY BE CHARGED) NAME AS IT APPEARS ON CREDIT CARD

Discover MasterCard VISA CREDIT CARD NUMBER EXPIRATION DATE (MM/YY) CARDHOLDER’S ZIP CODE

My signature below authorizes the Michigan Department of State to charge my account for the applicable fees.

_________________________________________________________________________________ ______________________

SIGNATURE OF CARDHOLDER (ADOBE SOFTWARE SIGNATURES ARE NOT ACCEPTED) DATE

FAX COMPLETED FORM WITH MAIL COMPLETED FORM WITH PAYMENT TO: MICHIGAN DEPARTMENT OF STATE CREDIT CARD PAYMENT TO 517‐636‐5865 (ALLOW 7‐10 BUSINESS DAYS TO SPECIAL SERVICES BRANCH

PROCESS REQUESTS SENT BY MAIL) 7064 CROWNER DRIVE LANSING, MI 48918

BDVR-162 (02/04/2021)