Form Center

2. 
3. Voter Registration Information Request

   City Clerk Jennifer A. Zelmanski

   (586) 445-5443

5. REQUESTOR INFORMATION
7. Candidate Name*
9. Organization*
11. Political Committee*
15. Requestor Name*
16. Requestor Email Address*
18. Requestor Address*
20. Requestor Phone Number*
21. Date of Request*
    Date of Request
23. Detailed Description of Request*
25. Pricing Information

    The City Clerk's Office will contact you with the total balance due based on your request.  All fees must be paid prior to processing your request.  Please allow two to three business days for processing once the request has been paid in full.

    • Voter Label Fee: $10 Setup plus $.50 per label sheet.
    • Voter Print-Out Fee: $10 Setup plus $.50 per page.
    • Voter Information C.D. Fee: $20
    • Voter Information Setup/Email Fee: $15
    • Voter Information Weekly Email Fee: $10
27. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
29. Electronic Signature*
31. Date*
33. Non-Electronic Submittal Instructions

    If you choose to print this application, please mail or hand deliver it to the City Clerk's Office- City of Roseville- 29777 Gratiot Avenue, Roseville, MI  48066.

    License will be issued by the City Clerk if approved.

Leave This Blank:


38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit

* indicates a required field