§ § 16.1-12-02.1Applicant's name placed upon ballot - Affidavit to accompany petition.

Upon receipt by the secretary of state of the certificate of nomination provided for in section
16.1-12-02 accompanied by the following affidavit, the secretary of state shall place the
applicant's name upon the general election ballot. The affidavit may be filed electronically,
through the mail, or by personal delivery, and must be in the possession of the appropriate filing
officer before four p.m. on the sixty-fourth day before the general or special election. If the
affidavit is filed electronically, the candidate shall retain the original copy. The affidavit must be
substantially as follows:

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 State of North Dakota )
) ss.
County of ________ )
I, ______________, being sworn, say that I reside at ______________, in the city of
__________________, in the county of_________________, state of North Dakota; and zip
code of____________; that I am a candidate for nomination to the office of
_________________ to be chosen at the general election to be held on _____________,
____, and I request that my name be printed upon the general election ballot as provided
by law, as a candidate of __________ party for said office. I am requesting that my name
be listed on the ballot as I have identified my ballot name below. I understand that
nicknames are allowed as part of my ballot name, but titles and campaign slogans are not
permissible. I have reviewed the requirements to hold office and I certify that I am qualified
to serve if elected.
_______________________________________
Ballot name requested
Date ______________ _______________________________________
Candidate's signature
Subscribed and sworn to before me on ______________, ______.
_______________________________________
Notary Public
NOTARY SEAL My Commission Expires ____________________