Form DE-36 "Driver License and Id Card Application" - Michigan

What Is Form DE-36?

This is a legal form that was released by the Michigan Secretary of State - a government authority operating within Michigan. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 1, 2019;
  • The latest edition provided by the Michigan Secretary of State;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form DE-36 by clicking the link below or browse more documents and templates provided by the Michigan Secretary of State.

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Download Form DE-36 "Driver License and Id Card Application" - Michigan

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Customer: Please complete the area inside the black box by printing in ink.
MICHIGAN DEPARTMENT OF STATE DRIVER LICENSE AND ID CARD APPLICATION
Making a false statement on a driver license or ID card application can result in fines or criminal prosecution and action against your driving privilege.
Department personnel will notify law enforcement if they believe a fraudulent application is being made.
YES
ARE YOU A CITIZEN OF THE UNITED STATES?
FULL LEGAL NAME (First)
(Middle)
(Last)
NO
YES
ARE YOU A RESIDENT OF THE STATE OF MICHIGAN?
RESIDENCE ADDRESS (Required)
NO
IN THE LAST SIX MONTHS*, HAVE YOU HAD A MEDICAL
YES
CONDITION WHICH AFFECTED YOUR ABILITY TO DRIVE?
CITY
ZIP
NO
(*Twelve months if applying for a chauffeur or commercial driver license.)
IN THE LAST SIX MONTHS*, HAVE YOU HAD A FAINTING SPELL,
CHECK ONE:
YES
BLACKOUT, SEIZURE, OR OTHER LOSS OF CONSCIOUSNESS?
MALE
FEMALE
NO
COUNTY
(*Twelve months if applying for a chauffeur or commercial driver license.)
YES
IS YOUR DRIVER LICENSE CURRENTLY SUSPENDED, REVOKED,
CANCELLED OR DENIED IN MICHIGAN OR ANY OTHER STATE?
DATE OF BIRTH (Month/Day/Year)
HEIGHT (FT/IN)
WEIGHT
NO
YES
WILL YOU BE OPERATING A MOTORCYCLE ON PUBLIC ROADS?
NO
PHONE NUMBER/EMAIL
EYE COLOR
YES
YOUR NAME ADDED TO THE
ORGAN DONOR REGISTRY?
NO
PERMANENT MAILING ADDRESS (If different from residence)
YOUR
YES
DRIVER LICENSE OR PERSONAL ID?
(Proof of honorable or under honorable conditions (general) discharge required.)
NO
MAILING ADDRESS CITY
STATE
ZIP CODE
To be eligible to vote, you must be:
• a United States citizen
We will not share your
• at least 18 years old
driver license and social
• a 30-day resident of your city or township in Michigan
security number, day and
We will register you to vote unless you check the box below.
month of birth, email, phone
number (or decision to
Do not use my information for voter registration.
not register). Some voter
registration information,
I hereby certify, under penalty of perjury, that the information contained on this application is true
however, is public.
and correct, and that a court is not holding my license. I understand that if I have provided false
information to apply to register to vote, I may be subject to Federal or State criminal penalties.
Applicant, sign here
Today's date
X
* * * ( T H E S E C T I O N S B E L O W A R E F O R D E P A R T M E N T A L U S E O N L Y ) * * *
APPLICATION TYPE (Circle one)
LICENSE TYPE
GROUP DESIGNATION
ENDORSEMENTS
O
C
M
GDL 1 GDL 2 GDL 3 PID
A
B
C
CY
F
H
N P R S
T SEAS.
TIP
ORIG.
REN.
DUP.
CORR.
VAL.
SOCIAL SECURITY DOCUMENT PRESENTED
CORRECTIVE LENS?
CDL RESTRICTIONS
SAVE CASE NUMBER
Refer to Skills Test Certificate or Record
YES
NO
of Certificate in CSTIMS
LEGAL PRESENCE DOCUMENT PRESENTED
U.S. BIRTH CERTIFICATE
STATE
COUNTY
FILE #
(original or certified copy)
U.S. PASSPORT OR PASSPORT CARD
DAT
CONSULAR REPORT OF BIRTH ABROAD
ISSUE DATE
FILE #
(FS-240, DS-1350, FS-545)
CERTIFICATE OF CITIZENSHIP
ISSUE DATE
ALIEN #
CERTIFICATE #
(N-560, N-561)
CERTIFICATE OF NATURALIZATION
ISSUE DATE
ALIEN #
CERTIFICATE #
(N-550, N-570, N-578)
EXP. DATE
DL/PID NUMBER #
ENHANCED MICHIGAN DL/PID
PERMANENT RESIDENT CARD (I-551)
DATE
(valid, unexpired)
EMPLOYMENT AUTHORIZATION CARD
ISSUE DATE
EXP. DATE
#
(EAD)
U.S. VISA
TYPE (F-1, J-1 etc.)
EXP. DATE
FILE #
(immigrant or non-immigrant)
COUNTRY
EXP. DATE
FILE #
FOREIGN PASSPORT WITH PORT OF ENTRY STAMP
ARRIVAL AND DEPARTURE FORM
ISSUE DATE
EXP. DATE
FILE #
(I-94)
DE-36 (07/19)
uthority granted under Public Act 300 of 1949, as amended
.
Customer: Please complete the area inside the black box by printing in ink.
MICHIGAN DEPARTMENT OF STATE DRIVER LICENSE AND ID CARD APPLICATION
Making a false statement on a driver license or ID card application can result in fines or criminal prosecution and action against your driving privilege.
Department personnel will notify law enforcement if they believe a fraudulent application is being made.
YES
ARE YOU A CITIZEN OF THE UNITED STATES?
FULL LEGAL NAME (First)
(Middle)
(Last)
NO
YES
ARE YOU A RESIDENT OF THE STATE OF MICHIGAN?
RESIDENCE ADDRESS (Required)
NO
IN THE LAST SIX MONTHS*, HAVE YOU HAD A MEDICAL
YES
CONDITION WHICH AFFECTED YOUR ABILITY TO DRIVE?
CITY
ZIP
NO
(*Twelve months if applying for a chauffeur or commercial driver license.)
IN THE LAST SIX MONTHS*, HAVE YOU HAD A FAINTING SPELL,
CHECK ONE:
YES
BLACKOUT, SEIZURE, OR OTHER LOSS OF CONSCIOUSNESS?
MALE
FEMALE
NO
COUNTY
(*Twelve months if applying for a chauffeur or commercial driver license.)
YES
IS YOUR DRIVER LICENSE CURRENTLY SUSPENDED, REVOKED,
CANCELLED OR DENIED IN MICHIGAN OR ANY OTHER STATE?
DATE OF BIRTH (Month/Day/Year)
HEIGHT (FT/IN)
WEIGHT
NO
YES
WILL YOU BE OPERATING A MOTORCYCLE ON PUBLIC ROADS?
NO
PHONE NUMBER/EMAIL
EYE COLOR
YES
YOUR NAME ADDED TO THE
ORGAN DONOR REGISTRY?
NO
PERMANENT MAILING ADDRESS (If different from residence)
YOUR
YES
DRIVER LICENSE OR PERSONAL ID?
(Proof of honorable or under honorable conditions (general) discharge required.)
NO
MAILING ADDRESS CITY
STATE
ZIP CODE
To be eligible to vote, you must be:
• a United States citizen
We will not share your
• at least 18 years old
driver license and social
• a 30-day resident of your city or township in Michigan
security number, day and
We will register you to vote unless you check the box below.
month of birth, email, phone
number (or decision to
Do not use my information for voter registration.
not register). Some voter
registration information,
I hereby certify, under penalty of perjury, that the information contained on this application is true
however, is public.
and correct, and that a court is not holding my license. I understand that if I have provided false
information to apply to register to vote, I may be subject to Federal or State criminal penalties.
Applicant, sign here
Today's date
X
* * * ( T H E S E C T I O N S B E L O W A R E F O R D E P A R T M E N T A L U S E O N L Y ) * * *
APPLICATION TYPE (Circle one)
LICENSE TYPE
GROUP DESIGNATION
ENDORSEMENTS
O
C
M
GDL 1 GDL 2 GDL 3 PID
A
B
C
CY
F
H
N P R S
T SEAS.
TIP
ORIG.
REN.
DUP.
CORR.
VAL.
SOCIAL SECURITY DOCUMENT PRESENTED
CORRECTIVE LENS?
CDL RESTRICTIONS
SAVE CASE NUMBER
Refer to Skills Test Certificate or Record
YES
NO
of Certificate in CSTIMS
LEGAL PRESENCE DOCUMENT PRESENTED
U.S. BIRTH CERTIFICATE
STATE
COUNTY
FILE #
(original or certified copy)
U.S. PASSPORT OR PASSPORT CARD
DAT
CONSULAR REPORT OF BIRTH ABROAD
ISSUE DATE
FILE #
(FS-240, DS-1350, FS-545)
CERTIFICATE OF CITIZENSHIP
ISSUE DATE
ALIEN #
CERTIFICATE #
(N-560, N-561)
CERTIFICATE OF NATURALIZATION
ISSUE DATE
ALIEN #
CERTIFICATE #
(N-550, N-570, N-578)
EXP. DATE
DL/PID NUMBER #
ENHANCED MICHIGAN DL/PID
PERMANENT RESIDENT CARD (I-551)
DATE
(valid, unexpired)
EMPLOYMENT AUTHORIZATION CARD
ISSUE DATE
EXP. DATE
#
(EAD)
U.S. VISA
TYPE (F-1, J-1 etc.)
EXP. DATE
FILE #
(immigrant or non-immigrant)
COUNTRY
EXP. DATE
FILE #
FOREIGN PASSPORT WITH PORT OF ENTRY STAMP
ARRIVAL AND DEPARTURE FORM
ISSUE DATE
EXP. DATE
FILE #
(I-94)
DE-36 (07/19)
uthority granted under Public Act 300 of 1949, as amended
.
IDENTITY DOCUMENT PRESENTED
U.S./CANADIAN DRIVER LICENSE or PID
STATE
DL/PID #
EXP. DATE
(valid or expired less than 4 years)
FOREIGN PASSPORT
COUNTRY
EXP. DATE
FILE #
(valid or expired less than 1 year)
U.S. LEGAL DOCUMENTS
STATE
TYPE
FILE #
(marriage, divorce, adoption, legal name change)
PHOTO ID CARD (issued by U.S. military, or federal, Michigan
ISSUE DATE
EXP. DATE
FILE #
or tribal government agency)
U.S. SCHOOL RECORDS
ID TYPE
SCHOOL, CITY, STATE, TELEPHONE #
(photo, diploma, transcript, yearbooks)
MDOC PRISONER ID CARD
FILE #
(requires verification)
TYPE
FILE #
OTHER
RESIDENCY DOCUMENTS PRESENTED (at least two documents required)
TYPE
TYPE
RESIDENCY DOCUMENTS
EMPLOYEE SIGNATURE
MANAGER OR DESIGNEE SIGNATURE
BRANCH NUMBER
X
X
ADDITIONAL
C
E
R
O
F
Refer App? (Circle one)
Request for exception?
YES
NO
INFORMATION
CDL
ENFORCE
RESEARCH
OTHER
FOREIGN ADDRESS
DOCUMENTS IN POSSESSION OF?
Applicant
Mailed In-House
TRANSACTION #S, INCLUDING VOIDS
Branch
COMMENTS
BE SPECIFIC: (If referring this application, an explanation is REQUIRED. Use additional pages if needed. Print name, sign and date at the bottom).
________________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________
Any act or attempted act of cheating, as determined by the Secretary of State, may result in immediate test failure and denial of testing privileges for up to 60
days. All testing materials must be returned to the Secretary of State immediately after completing a test. The copying or distribution of test materials is
strictly prohibited. All personal electronic devices must be turned off and stored out of sight. Any use of personal electronic devices in the testing area is
strictly prohibited.
X
APPLICANT SIGNATURE
DATE (Month/Day/Year)___________________
_________________________________________________________________
X
INTERPRETER SIGNATURE (IF APPLICABLE)_______________________________________
DLN / PID______________________________
FOREIGN LANGUAGE INTERPRETED_______________________________
WRITTEN/ORAL TEST RESULTS
CDL TEST RESULTS
Air Brakes
General Knowledge
Enter Date and Pass or Fail Test Score
P______ F______
____/____/____
____/____/____
P______ F______
Operator
P______ F______
____/____/____
_____/_____/_____
P______ F______
____/____/____
P______ F______
P______ F______
____/____/____
_____/_____/_____
P______ F______
____/____/____
P______ F______
Passenger
Road Sign Test
P______ F______
Combination Vehicle
____/____/____
P______ F______
_____/_____/_____
P______ F______
____/____/____
P______ F______
____/____/____
P______ F______
_____/_____/_____
P______ F______
____/____/____
P______ F______
____/____/____
Moped
____/____/____
P______ F______
P______ F______
_____/_____/_____
School Bus
P______ F______
P______ F______
_____/_____/_____
Double Trailers
____/____/____
Motorcycle
P______ F______
____/____/____
P______ F______
____/____/____
P______ F______
_____/_____/_____
P______ F______
____/____/____
P______ F______
____/____/____
P______ F______
_____/_____/_____
____/____/____
P______ F______
Hazmat Test Results
Recreational Double
P______ F______
Tanker
_____/_____/_____
_____________________________
P______ F______
____/____/____
P______ F______
_____/_____/_____
Kiosk Tester Unique ID Number:
____/____/____
Chauffeur
P______ F______
_____/_____/_____
P______ F______
____/____/____
P______ F______
_____________________________
_____/_____/_____
P______ F______
Hazardous Materials (No Oral Test or Foreign Language Test Allowed)
______________________________________
Manager or Designee Signature
____/____/____
P_____ F_____
____/____/____
P_____ F_____
____/____/____
P_____ F_____
____/____/____
P_____ F_____
Date:___________________________________
If necessary, attach an additional DE-36 to record more test scores OR application referral information.
07/19
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