Compiled Laws, Chapter 168. Michigan Election Law § 168.495

(a) The name of the applicant.

(b) The residence address of the applicant, including the street and number or rural route and box number and the apartment number, if any.

(c) The city or township and county of residence of the applicant.

(d) The date of birth of the applicant.

(e) The driver license or state personal identification card number of the applicant, if available.

(f) A statement that the applicant is a citizen of the United States.

(g) For voter registration, a statement that the applicant is at the time of completing the affidavit, or will be on the date of the next election, not less than 18 years of age, and for preregistration to vote, a statement that the applicant is at the time of completing the affidavit at least 16 years of age.

(h) For voter registration, a statement that the applicant has or will have lived in this state not less than 30 days before the next election, and for preregistration to vote, a statement that the applicant has lived in this state for at least 30 days.

(i) For voter registration, a statement that the applicant has or will have established the applicant's residence in the township or city in which the applicant is applying for registration not less than 30 days before the next election, and for preregistration to vote, a statement that the applicant has established the applicant's residence in the township or city in which the applicant is applying for preregistration for at least 30 days.

(j) A statement that the applicant must be at least 18 years of age on or before the date of an election to vote in that election.

(k) A space in which the applicant must state the place of the applicant's last registration, if any.

(l) A statement that the registration is not effective until processed by the clerk of the city or township in which the applicant resides.

(m) A statement that the applicant, if qualified, may vote at an election occurring on or after the date of completing the application.

(n) A statement authorizing the cancellation of registration at the applicant's last place of registration.

(o) A space for the applicant to sign and certify to the truth of the statements on the application.