If the applicant is unable to sign the applicant's name, the applicant shall mark or use the applicant's signature stamp on the application in
the presence of a disinterested individual. The disinterested individual shall print the name of the individual marking the "X" or using the
signature stamp below the "X" or signature and shall sign the disinterested individual's own name following the printed name together with the
notation "witness to the mark."
North Dakota ID Type Used: (check one)
Check ONE (if applicable):
If one of the check boxes above applies to you, please indicate your preferred ballot delivery method:
SFN 51468 (08-2015)
Mail or Submit to the Auditor of Your County of Residence or Appropriate Election Officer
Voter's Name
ID Number (required only if driver's license, non-driver's ID, tribal ID, passport or military ID is selected above)
Date of Birth
Residential Address
Daytime Telephone Number
Ballot Delivery Address (if different from residential address)
Driver's License
Applicant Without ID*
Long Term Care Certificate
(include with application)
Non-driver's ID
Tribal ID
Passport or Military ID (only for voters outside the United States)
Signature (required)
I do solemnly affirm that I have resided or will reside in the precinct, where my residential voting address is located, for at least thirty days
next preceding the election and will be a qualified elector of the precinct.
Printed Name of Person Making Mark or Voter's Signature Stamp
Signature of "Witness to the Mark"
Voter's Mark
For Office Use Only
Precinct Part
For reference, see North Dakota Century Code, Chapter 16.1-07.
Application must be for at least one of the following elections:
June (Primary) Election
City Election
All Statewide Elections
(only check if ballot delivery
address will be the same for
all elections)
Special Election
School Election
November (General) Election
Applicant Information: (ALL FIELDS REQUIRED)
Applicant Unable to Sign:
*Applicant Without ID:
Active Military and Overseas Voter:
If the applicant does not possess or cannot secure an approved form of identification due to a disability with which the individual lives and
which prevents the individual from traveling to obtain, another qualified elector of the state may attest that the applicant is a qualified elector
of that precinct by signing below and providing his or her approved North Dakota identification number. NOTE: A qualified elector may not
attest the qualifications of more than four applicants in an election.
Printed Name of Attester
Signature of Attester
Daytime Telephone Number
Driver's / Non-driver's / Tribal ID Number
Citizen living outside of the United States
Uniformed service or family member living away from the voter's residence, yet within the United States
Uniformed service or family member living away from the voter's residence, yet outside the United States
Fax (provide fax number):
Email (provide email address):
Complete, Print, Sign, and Mail