Fillable PART 1 APPLICANT'S INFORMATION - michigan

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APPLICATION FOR A CERTIFIED COPY PART 1: APPLICANT'S INFORMATION PHOTO IDENTIFICATION REQUIRED SENIOR BIRTH RECORD Applicant's State Drivers License Name:___ or Identification # ___ Mailing Address: ___ City: ___ State: ___ Zip: ___ (Cannot Send to General Delivery) Daytime Phone - Required: ( ) ___ Other Phone: ( PHOTO IDENTIFICATION REQUIRED )
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