Application To Vote Poll List - State Of Michigan printable pdf download

Application To Vote Poll List - State Of Michigan

Application to Vote – Poll List

Picture identification requirement: All Michigan voters must show a Michigan driver’s license, a Michigan

personal identification card or some other acceptable form of picture identification before voting. A voter who

is unable to show picture identification can vote after signing an affidavit attesting that he/she is not in

possession of picture identification.

Date of Election

Precinct

ELECTION

INSPECTOR

PRINT NAME: _________________________________________________________________________________

COMPLETES



AFFIDAVIT ON

DATE OF BIRTH: _____________________________________________

REVERSE

COMPLETED

RESIDENCE ADDRESS: ________________________________________________________________________

ELEC INSP. INITIAL

I certify that I am a United States citizen and a registered and qualified elector in this

precinct and hereby make application to vote at this election.

BALLOT STYLE

BALLOT NO.

SIGN HERE

X__________________________________________________________________________

SIGNATURE OF VOTER

VOTER NO.

----------------------------------------------------------------------------------------------------------------------------

AFFIDAVIT OF VOTER NOT IN POSSESSION

ATION

OF PICTURE IDENTIFIC

hereby affirm that I am not in possession

(Print Name)

of a driver’s license, a state-issued personal identification card or any other acceptable form of picture identification and

wish to vote.

By signing this affidavit, I swear that the statements made above are true.

SIGNATURE OF VOTER: Х

Penalty: Making a false statement in this affidavit is perjury, punishable by a fine up to $1,000.00 or imprisonment for up

to 5 years, or both.

To be completed by Election Inspector

Sworn and subscribed to before me this

day of

I certify that the elector named above has completed the above affidavit in my presence.

Signature of Election Inspector

Application To Vote Poll List - State Of Michigan