ABSENTEE/MAIL BALLOT APPLICATION
SECRETARY OF STATE
SFN 51468 (10-2023)
For Office Use Only
Precinct Part
______________
Applicant Information: (ALL FIELDS REQUIRED)
Voter's name Date of birth
Daytime telephone number
North Dakota ID type used: (check one)
Driver's license Non-driver's ID
Long-term care certificate (include with application)
Tribal ID
Passport (only for voters living outside the United States) or military ID** Applicant without ID*
ID number (required only if driver's license, non-driver's ID, tribal ID, passport, or military ID is selected above)
Residential address City State ZIP code
Ballot delivery address (if different from residential address) City State ZIP code
I do solemnly affirm that I have resided or will reside in the precinct where my residential voting address is located for at least 30 days next
preceding the election and will be a qualified elector of the precinct.
Signature (required)
Date
Applicant Unable to Sign:
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."
Voter's Mark
Printed name of person making mark or voter's signature stamp
Signature of "witness to the mark"
*Applicant Without ID:
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 applications in an election.
Printed name of attester Driver's / non-driver's / tribal ID number
Date
Signature of attester
Daytime telephone number
**Active Military and Overseas Voter:
Check ONE (if applicable):
If one of the check boxes above applies to you, please indicate your preferred ballot delivery method:
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
Mail Email (provide email address): Fax (provide fax number):
Mail or submit to the auditor of your county of residence or appropriate election officer
(The signature on this affidavit will be compared to the signature on the affidavit on the envelope in which the absentee ballot must be placed.)
For reference, see North Dakota Century Code, Chapter 16.1-07.
Application must be for at least one of the following elections: (check all that apply)
School or school special election
State or county special electionJune (Primary) election
November (General) election
City or city special election
