Get Mi Bdvr-162 2011

Requests received after 4 00 p.m. Eastern Time will be processed on the next business day. Please allow 7-10 business days to process requests sent by mail. Mail completed application with a check or money order payable to State of Michigan to Michigan Department of State Out of State Resident Services Unit Lansing Michigan 48918 BDVR-162 05/11. APPLICATION FOR DRIVER S LICENSE REINSTATEMENT Clear Form PLEASE PRINT OR TYPE NAME FIRST MIDDLE LAST STREET ADDRESS CITY STATE ZIP MAILING ADDRESS if different from Street Address DAYTIME TELEPHONE NUMBER EXTENSION - FAX NUMBER MICHIGAN DRIVER S LICENSE NUMBER DATE OF BIRTH PAYMENT METHOD check one REINSTATEMENT FEE TYPES check those applicable Money Order payable to the State of Michigan Standard 125. 00 Check payable to the State of Michigan Minor in Possession MIP 125. 00 Credit Card State of Michigan only accepts Discover MasterCard or VISA Drug Crime 125. 00 Friend of the Court Compliance Certificate must accompany payment 85. 00 COMMENTS Watercraft 125. 00 Snowmobile 125. 00 Credit Card Number Credit Card Expiration Date / Enter Total Fees Here NAME ON CREDIT CARD PLEASE PRINT My signature below authorizes the Michigan Department of State to charge my account. Signature of Cardholder Date If paying by credit card you may fax this completed application to 517 322-5438. APPLICATION FOR DRIVER S LICENSE REINSTATEMENT Clear Form PLEASE PRINT OR TYPE NAME FIRST MIDDLE LAST STREET ADDRESS CITY STATE ZIP MAILING ADDRESS if different from Street Address DAYTIME TELEPHONE NUMBER EXTENSION - FAX NUMBER MICHIGAN DRIVER S LICENSE NUMBER DATE OF BIRTH PAYMENT METHOD check one REINSTATEMENT FEE TYPES check those applicable Money Order payable to the State of Michigan Standard 125. 00 Check payable to the State of Michigan Minor in Possession MIP 125. 00 Credit Card State of Michigan only accepts Discover MasterCard or VISA Drug Crime 125. 00 Check payable to the State of Michigan Minor in Possession MIP 125. 00 Credit Card State of Michigan only accepts Discover MasterCard or VISA Drug Crime 125. 00 Friend of the Court Compliance Certificate must accompany payment 85. 00 COMMENTS Watercraft 125. 00 Friend of the Court Compliance Certificate must accompany payment 85. 00 COMMENTS Watercraft 125. 00 Snowmobile 125. 00 Credit Card Number Credit Card Expiration Date / Enter Total Fees Here NAME ON CREDIT CARD PLEASE PRINT My signature below authorizes the Michigan Department of State to charge my account. 00 Snowmobile 125. 00 Credit Card Number Credit Card Expiration Date / Enter Total Fees Here NAME ON CREDIT CARD PLEASE PRINT My signature below authorizes the Michigan Department of State to charge my account. Signature of Cardholder Date If paying by credit card you may fax this completed application to 517 322-5438. APPLICATION FOR DRIVER S LICENSE REINSTATEMENT Clear Form PLEASE PRINT OR TYPE NAME FIRST MIDDLE LAST STREET ADDRESS CITY STATE ZIP MAILING ADDRESS if different from Street Address DAYTIME TELEPHONE NUMBER EXTENSION - FAX NUMBER MICHIGAN DRIVER S LICENSE NUMBER DATE OF BIRTH PAYMENT METHOD check one REINSTATEMENT FEE TYPES check those applicable Money Order payable to the State of Michigan Standard 125. 00 Check payable to the State of Michigan Minor in Possession MIP 125. 00 Credit Card State of Michigan only accepts Discover MasterCard or VISA Drug Crime 125. 00 Friend of the Court Compliance Certificate must accompany payment 85. 00 COMMENTS Watercraft 125. .