Rights Restoration Form

Rights Restoration Information Form

This form is used to request required information to assist returning citizens to request the reinstatement of rights that have been revoked, usually due to a criminal conviction. Upon the completion of this form, you may receive a follow-up call regarding additional information.
Name

First NameLast Name
Phone Number

Area CodePhone Number
Email
example@example.com
Date of Birth

MonthDayYear
Date
MaleFemale
WhiteBlack or African AmericanAmerican Indian or Alaska NativeAsianNative Hawaiian or Other Pacific IslanderOther
Present Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County of Present Address
MDOC Number
County of Conviction
Year of Conviction
ArsonArmed RobberyBigamyBriberyEmbezzlementExtortionFelony Bad CheckFelony ShopliftingForgeryLarcenyMurderObtaining Money or Goods under False PretensesPerjuryRapeReceiving Stolen PropertyRobberyTheftTimber LarcenyUnlawful Taking of Motor VehicleStatutory RapeCarjackingLarceny under Lease or Rental AgreementVoter Fraud
YesNoNot Sure (Need Followup)
Please provide a small bio! This bio should include your name, achievements, work-life, family, and what it means to get your rights restored.
Should be Empty:

Rights Restoration Information Form