BDVR-162 Application for Driver's License Reinstatement

OUT-OF-STATE RESIDENT APPLICATION FOR DUPLICATE DRIVER¡¯S LICENSE OR STATE ID

AND/OR DRIVER¡¯S LICENSE REINSTATEMENT

PRINT FORM

MICHIGAN DEPARTMENT OF STATE

CLEAR FORM

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

ONE-TIME OUT-OF-STATE MAILING ADDRESS

CITY

STATE

ZIP

MI

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

Reinstatement Fee Types (check those applicable):

Standard - $125

Minor in Possession (MIP) - $125

Watercraft - $125

Snowmobile - $125

Friend of the Court - Compliance Certificate must accompany $85

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 SOS.

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 (for Michigan residents only)

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 register to vote, you must be a United States citizen, at least 17.5 years old (18 years old when you vote), a Michigan resident (at the time you

register), and a resident of your city or township for at least 30 days (when you vote). 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 (for duplicate driver¡¯s license or state ID only)

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)

Amex

Discover

VISA

CREDIT CARD NUMBER

EXPIRATION DATE (MM/YY)

CARDHOLDER¡¯S ZIP CODE

[Grab your reader¡¯s attention with a

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

CREDIT CARD PAYMENT TO 517-636-5865

BDVR-162 (04/19/2022)

MasterCard

NAME AS IT APPEARS ON CREDIT CARD

MAIL COMPLETED FORM WITH PAYMENT TO: MICHIGAN DEPARTMENT OF STATE

(ALLOW 7-10 BUSINESS DAYS TO

INTERNAL SERVICES SECTION

PROCESS REQUESTS SENT BY MAIL)

7064 CROWNER DRIVE

LANSING, MI 48918

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download