Milwaukee County Register of Deeds Request for a Free Birth Record needed to Obtain an I.D. Card for Purposes of Voting

YOUR Name (Please Print)

YOUR Street Address Apt. No.

BIR

TH

RE

CO

RD

I

NF

OR

MA

TIO

N

City / State / Zip

I hereby request one birth certificate at no cost for the purpose of obtaining an operator’s license* or an identification card** for purposes of voting. I attest (declare) that I have not previously received a state issued identification and have not previously received a free birth record from the Milwaukee County Register of Deeds. ___________________________________ _____/_____ /2012 Signature (of person named on birth record) Date *Issued under Chapter 343 of the state statutes **Issued under section 343.50 of the statutes