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Get MI DCH-0569-SB 2015

Te after June 1, 2003. PART 1: APPLICANT’S INFORMATION www.michigan.gov/vitalrecords Applicant’s State Driver’s License Name:__________________________________________________ or Identification # ________________________ Mailing Address: ________________________________ City: ____________________ State: _____ Zip: _________ (Cannot Send to General Delivery) Daytime Phone - Required: ( ) _______________________ Other Phone: ( CURRENT VALID GOVERNMENT ISSUED PHOTO ID REQUIRED PART 2: ).

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