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2. Driver's Application
4. Last Name*
5. First Name*
6. Middle Initial*
8. Ethnicity*
9. Sex*
   -- Select One --MaleFemale
11. Month of Birth*
12. Day of Birth*
13. Year of Birth*
15. Other Names:
17. Copy of Valid Driver's License*
    Please upload a copy of the driver's valid Michigan driver's license.
Leave This Blank:


19. Submit

* indicates a required field