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Application Form for Disassociated Persons List - State of Michigan - michigan 2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering your full legal name at the top of the form. Ensure that you include your first, middle, and last names accurately.
  3. Fill in your home address, including street number, city, state, and zip code. This information is crucial for identification purposes.
  4. Provide your Social Security Number and Driver’s License Number along with the state of issuance. This helps verify your identity.
  5. Complete the personal details section by indicating your date of birth, sex, height, weight, hair color, eye color, and any noticeable physical characteristics.
  6. Answer the series of yes/no questions on page 2 honestly. Mark 'Y' for yes and 'N' for no as applicable to ensure a smooth application process.
  7. Initial each page as required to confirm that you have read and understood all sections before proceeding to sign the application at your appointment.

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