SFN 18440 (11-09) Page 4
CERTIFICATE OF ACCEPTANCE
ELECTOR #2
I, ______________________________________________________, being duly sworn, depose and say that I
candidate name
reside 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_____________________________________
CERTIFICATE OF ACCEPTANCE
ELECTOR #3
I, ______________________________________________________, being duly sworn, depose and say that I
candidate name
reside 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_____________________________________