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Get MI DCH-0847 2015

FEE TO: Vital Records Changes P.O. Box 30721 Lansing MI 48909 (PERSON REQUESTING CHANGE OR CORRECTION) PLEASE PRINT CLEARLY AND LEGIBLY Applicant’s Name: Driver’s License or State Identification #: Address: (Cannot send to General Delivery) Daytime Phone Required: City/State: ( Zip: Other Phone: ) ( ) To protect you from identity theft, we require PHOTO IDENTIFICATION to be presented along with this application. (See back for details) ELIGIBILITY (Please check which category .

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