1. 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)
BIRTH RECORD
INFORMATION
YOUR Street Address Apt. No.
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