PETITION/CERTIFICATE OF NOMINATION SECRETARY OF STATE SFN 02704 (12-2017) Secretary of State State of North Dakota 600 E Boulevard Ave Dept 108 Bismarck ND 58505-0500 Telephone: (701) 328-4146 Toll-Free: (800) 352-0867, option 6 Fax: (701) 328-3413 Email: soselect@nd.gov Website: Vote.ND.Gov SEE BOTTOM OF PAGE FOR INSTRUCTIONS.Please print.Nominating provisions are found in North Dakota Century Code, Sections 16.1-11-06, 16.1-11-15, 16.1-11-16, 16.1-12-02.3, and 40-21-07. CERTIFICATE OF NOMINATION Area affected by petition Candidate First Name Candidate Last Name Candidate Telephone Number Candidate Mailing Address City State ZIP Code Office candidate is seeking Term Full Unexpired District Number (if applicable) District Name (if applicable) Judgeship Number (if applicable) Political party affiliation of candidate* *The No-Party designation must be used for all county, judicial, multi-district, and city offices, and the office of Superintendent of Public Instruction. All othercandidates must designate a political party or independent. Republican Democratic-NPL Libertarian Other: independent candidate No-Party Election (select Primary if the office will appear on both the Primary and General Election ballot) City Primary General Special Date of Election If the petition is for the office of governor, complete the following information: Name of lieutenant governor candidate Address (street address or rural route) City State ZIP Code INSTRUCTIONS FOR PETITION/CERTIFICATE OF NOMINATION WHEN TO CIRCULATE: Candidates may not begin circulating the Petition/Certificate of Nomination prior to January 1 preceding the election. HOW TO CIRCULATE: Each individual Petition/Certificate of Nomination must be circulated with the completed information shown above and must be made available to each signer at the time of signing. Only qualified electors of the affected area, as the case may be, may sign nominating petitions. In addition to signing the person's name, petition signers shall include: the date of signing; their complete residential address, rural route, or general delivery; and either the name of the North Dakota city or its corresponding ZIP code. Incomplete signatures or accompanying information of petition signers that do not meet the requirements of Section 16.1-11-16 invalidate such signatures. The use of ditto marks to indicate that the information contained on the previous signature line carries over does not invalidate a signature. Signatures that are not accompanied by a complete date are not invalid if the signatures are preceded and followed by a signature that is accompanied by a complete and valid date. WHO FILES: The Petition/Certificate of Nomination must be filed by all candidates petitioning to have their names placed on the ballot for federal,statewide, judicial district, legislative, county, multi-district, and city offices in North Dakota. WHEN TO FILE: The Petition/Certificate of Nomination must be filed before 4 p.m. of the 64th day, prior to any election. If the Petition/Certificate of Nomination is mailed, it must be in the physical possession of the appropriate filing officer before 4 p.m. of the 64th day prior to the election. Federal, statewide, judicial district, legislative, county, and multi-district candidates, must accompany this form with an Affidavit of Candidacy SFN 2703 and Statement of Interests SFN 10172. WHERE TO FILE: FEDERAL, STATEWIDE, JUDICIAL, AND LEGISLATIVE DISTRICT CANDIDATES: If this form was completed using the online Candidate Forms Completion and Filing System for Ballot Access, either upload the form into the online Candidate Forms Completion and Filing System for Ballot Access or file it with the Secretary of State by mail, hand delivery, email, or fax. If this form was handwritten or typed, file with the Secretary of State by mail, hand delivery, email, or fax. COUNTY AND MULTI-DISTRICT CANDIDATES - File with the County Auditor in their county of residence. CITY CANDIDATES - File with the City Auditor ASSISTANCE: Questions regarding the Petition/Certificate of Nomination may be directed to the Elections Unit of the Secretary of State's office at (701) 328-4146 or (800) 352-0867 or the appropriate filing officer. American LegalNet, Inc. www.FormsWorkFlow.com SFN 02704 (12-2017)NOMINATING PETITION The Petition/Certificate of Nomination may be photocopied to accommodate additional signatures. Number Date (mm/dd/yy) Name of Voter Complete Residential, Rural Route, or General Delivery Address (PO BOX IS NOT ACCEPTABLE) Street/Rural RouteCityStateZIP Code 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com