Form Sfn 18440 - Certificate Of Write-In Candidacy President Of The United States Page 3
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4SFN 18440 (11-09) Page 3
CERTIFICATE OF ACCEPTANCE / ELECTORS FOR PRESIDENT OF THE UNITED STATES
INSTRUCTIONS
1.
North Dakota has three electoral votes for President of the United States of America. The write-in candidate must
provide the names and complete post-office addresses of his/her three electors on the certificate of write-in candidacy.
Each of the candidate's three electors must complete a sworn certificate of acceptance verifying his/her name,
2.
complete post-office address and designation as an elector for the write-in presidential candidate. The three
certificates of acceptance are a part of this form.
CERTIFICATE OF ACCEPTANCE
ELECTOR #1
I, ______________________________________________________, being duly sworn, depose and say that I reside
candidate name
at _______________________________________________________, City of_________________________________,
street or route address
city
North Dakota, ___________________________; that I accept being designated one of three electors for
zip code
____________________________________________________ as a write-in candidate for President of the United
name of presidential candidate
States to be voted upon at the general election to be held on the _________ day of November, ________.
Signature of elector
VERIFICATION
State of _________________________
)
) ss.
County of ________________________
)
Subscribed and sworn to before me this _________ day of _____________________________, 20_____.
(Notary Seal/Stamp)
Notary Public
My Commission
Expires_____________________________________
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