STATE OF NORTH DAKOTA

COUNTY OF [County Name]

Introduction:

I, [YOUR NAME], being duly sworn, declare under penalty of perjury that the following statements are true and correct to the best of my knowledge:

Statement of Facts:

1. I, [YOUR NAME], born on [Date of Birth], hereby declare and affirm that the information provided herein is accurate and true to the best of my knowledge and belief.

2. If applicable, my North Dakota Driver’s License or State Identification Number is [License or ID Number].

3. This affidavit is executed with the intent to establish my residency within the jurisdiction necessary to qualify for participation in local elections as per the laws and regulations of the State of North Dakota.

4. I hereby affirm that my current physical residence is located at [YOUR ADDRESS], where I have resided for [Number of months/years].

5. This location serves as my primary and legal residence for all intents and purposes, including but not limited to, voter registration and participation in local elections within the State of North Dakota.

6. Should my residence at the above address be less than two years, it is noted that my previous address was [PREVIOUS ADDRESS], which also falls within the jurisdiction of the State of North Dakota.

Statement of Affirmation:

I hereby affirm that I am a resident of [County Name], North Dakota, and that I reside at the address stated above, which is within the jurisdiction of the local election district.

I make this affidavit for the purpose of establishing my eligibility to vote in local elections within the State of North Dakota.

I understand that providing false information on this affidavit constitutes a violation of the laws of the State of North Dakota and may subject me to penalties under the law.

Notarization:

Subscribed and sworn to (or affirmed) before me on this [Day] of [Month], [Year], by [YOUR NAME], who is personally known to me or has produced a driver's license as identification.

Signature:

[YOUR NAME]

[DATE]

[NOTARY PUBLIC NAME]

[DATE]

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