Precinct ______________________________________________
Name ________________________________________________
Residential Address _____________________________________
City ___________________________ ND Zip Code ____________
Under penalty of possible criminal prosecution for making a false statement, I swear that I reside at the residential address provided above, that I have resided in my precinct for at least thirty days next preceding the election, and this is the only ballot I will cast in this election.
Applicant's Signature ____________________________________
Date _________________________________________________
The signature on this affidavit will be compared to the signature on the affidavit included in the application for the absentee ballot.
N.D.C.C. § 16.1-07-08