Please indicate the date you are leaving Michigan.
Please indicate the (approximate) date you are returning to Michigan.
All email addresses provided will be for the sole use of the Office of the Portage City Clerk and are protected from any disclosure under Michigan election law.
Filling out the above form does not forward regular postal mail. To forward non-election mail, please visit the US Postal Service at www.usps.com/manage/forward.
I agree and understand that my typed name (electronic signature) is the legal equivalent of my manual/handwritten signature and I consent to be legally bound to this agreement.
This field is not part of the form submission.
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