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Legal Division: 330-725-9722 Title Division: 877-722-0016

Passport Application for Medina County Residents

You may print the passport application from this site, or obtain any of the forms listed below from our Medina County offices. The online version of these forms are provided in Adobe Acrobat PDF format. If you do not already have Adobe Acrobat Reader software, you can download it for free on the Adobe website.

All passport applicants must appear in person, including minors under age 16. Please review important information regarding passports for children under age 16 by reviewing this document.

Form DS-11 Application for Passport

Use this form if:

  • You have never had a US passport, OR
  • You are under age 16, OR
  • Your most recent passport was issued more than 15 years ago.

Form DS-82 Application for Passport by Mail

This form is for Renewals ONLY. It is used for renewing a previously issued U.S. passport (not processed by Clerk’s office or Auto Title, processed by mail only).

Use this form if:

  • I can submit my most recent passport, AND
  • I was at least 16 years old when my most recent passport was issued, AND
  • I was issued my most recent passport in the last 15 years, AND
  • I use the same name as on my most recent passport or since my passport was issued, I have had my name changed by marriage or court order and can submit proper documentation to reflect my name change.

If you answered NO to any of the 4 statements above, STOP.
You cannot use Form DS-82, you must apply using Form DS-11.

Form DS-3053 Statement of Consent
Issuance of a Passport to a Minor Under Age 16

This form is to be submitted, along with the DS-11 Application for Passport, for minors under age 16 as evidence of parental permission IF:

  • You are a non-applying parent or guardian consenting to passport issuance for your child, OR
  • You are an applying parent or guardian, and written consent of the non-applying parent or guardian cannot be obtained.

Form DS-5504 Name Change, Data Correction,
and Limited Passport Book Replacement

Use this form if:

  • I had a change in my name and my U.S. passport book and/or card was issued less than one year ago; OR
  • My identifying information in my most recent U.S. passport book and/or card was printed incorrectly; OR
  • My most recent U.S. passport book was limited in validity and was issued less than one year ago.

If you answered NO to ALL of the 3 statements above, STOP.
You cannot use Form DS-5504, you must apply on a DS-11 or DS-82 depending on your circumstances.

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