Do NOT use all uppercase. Only use proper upper and lower case.
Before you upload your face photo, please enter information in the first section in the order they are numbered.
If you are filling out this form for multiple people from one computer, please Click Here to reset everything before starting another.

Your Information

1. Your Current Full Name (First Middle Last)* (Include Jr., I, II, III - If on your Birth Certificate)

2. Man or Woman*

Select Man Woman

3. Born Day* (YYYY-MM-DD)

4. Your Email*
 

5. Maiden Last Name
(If not applicable leave blank)

6. Your Full Address*
Line 1: 123 Main Street
Line 2: City, State Zipcode

7. Birth Place*
(State or Province)

8. Current Home County*

Select County Alcona Alger Allegan Alpena Antrim Arenac Baraga Barry Bay Benzie Berrien Branch Calhoun Cass Charlevoix Cheboygan Chippewa Clare Clinton Crawford Delta Dickinson Eaton Emmet Genesee Gladwin Gogebic Grand Traverse Gratiot Hillsdale Houghton Huron Ingham Ionia Iosco Iron Isabella Jackson Kalamazoo Kalkaska Kent Keweenaw Lake Lapeer Leelanau Lenawee Livingston Luce Mackinac Macomb Manistee Marquette Mason Mecosta Menominee Midland Missaukee Monroe Montcalm Montmorency Muskegon Newaygo Oakland Oceana Ogemaw Ontonagon Osceola Oscoda Otsego Ottawa Presque Isle Roscommon Saginaw St. Clair St. Joseph Sanilac Schoolcraft Shiawassee Tuscola Van Buren Washtenaw Wayne Wexford

9. Pick the Declaration that applies to you

Select the Declaration that applies to you Declaration for Those Born in the 50 united States Declaration for American Federal Employees Declaration for Naturalized US Citizens

When the fields above are filled out and you have picked the declaration, then click the image box below to choose your photo and center your face. (Please use GIF JPEG or PNG image format)

Witnesses Information

Witness 1 Full Name (First Middle Last)*

Witness 2 Full Name (First Middle Last)*

Witness 1 Relation to you*

Witness 2 Relation to you*

Fill out at least one out of the address, phone, or email for each witness

Witness 1 Full Address*
(123 Main Street City, State Zipcode)

Witness 2 Full Address*
(123 Main Street City, State Zipcode)

Witness 1 Phone*

Witness 2 Phone*

Witness 1 Email*

Witness 2 Email*

Witness 1 County where signing*

Witness 2 County where signing*

Witness 1 State where signing*

Select State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Witness 2 State where signing*

Select State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Voter Revocation & Notice to Secretary of State

Lookup County Clerk information (click here) - Use the Search By Your Address field on the lookup page to
find the name and address of the clerk in the area you last registered in and copy and paste the information in
the appropriate fields below. The final letters will be added to your ticket by the recorder for you to print once
the registered label numbers are verified by the recorder.

Your address when you registered*
(Line #1 - 123 Main Street Line #2 - City, State Zipcode)

Voter Revocation - Name of Local Clerk*
 

Voter Revocation - Clerk Office Address*
(Line #1 - 123 Main Street Line #2 - City, State Zipcode)

Voter Revocation - Registered Label No.
(Filled out by Recorder)

Secretary of State - Registered Label No.
(Filled out by Recorder)

Status Declaration - Registered Label No.
(Filled out by Recorder)

Revoke Election to Pay Taxes NY - Registered Label No.
(Filled out by Recorder)

Revoke Election to Pay Taxes WA - Registered Label No.
(Filled out by Recorder)

Note: Please make sure you have entered all the information above (except the registered label fields) and you have clicked the Save Information button.
When you create or view your service desk ticket by clicking the button at the bottom of this page, you will have access to download, preview, and print your documents.