North Dakota Century Code Title 16.1. Elections § 16.1-11-10. Applicant's name placed upon ballot--Affidavit to accompany petition

 State of North Dakota

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 County of ______________

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  I, _______________, being sworn, say that I reside at _______________, in the city of _______________, in the county of _______________ of North Dakota; and zip code of _______________; that I am a candidate for nomination to the office of _______________ to be chosen at the primary election to be held on _______________, _______________, and I request that my name be printed upon the primary election ballot as provided by law, as a candidate of the _______________ 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.

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Ballot name requested

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Candidate's signature

  Subscribed and sworn to before me on _______________, __________.

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Notary Public

 NOTARY SEAL

My Commission Expires _______________________