Statement Of Interests
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Secretary of State
STATEMENT OF INTERESTS
State of North Dakota
600 E Boulevard Ave Dept 108
SECRETARY OF STATE
Bismarck ND 58505-0500
SFN 10172 (10-2015)
Telephone: (701) 328-4146
Toll-Free: (800) 352-0867, option 6
Fax: (701) 328-3413
SEE PAGE 4 FOR INSTRUCTIONS
Email: soselect@nd.gov
Website: Vote.ND.Gov
References to the Statement of Interests are found in North Dakota Century Code, Chapter 16.1-09.
FILING REQUIREMENTS FOR STATEMENT OF INTERESTS
1.
Every candidate for elective office shall file a Statement of Interests with the appropriate filing officer with whom the candidate filed his/her
Certificate of Endorsement SFN 17196 or Petition/Certificate of Nomination SFN 2704.
a.
Candidates for President and Vice President of the United States shall file with the Secretary of State either a Statement of Interests as
required by Chapter 16.1-09 of the North Dakota Century Code or a copy of the personal disclosure statement required by the Federal
Election Commission.
b.
Candidates for US Senate and US House of Representatives shall file this form with the Secretary of State or a copy of the personal
disclosure statement required by the Federal Election Commission.
c.
Candidates for statewide office shall file with the Secretary of State.
d.
Candidates for legislative office shall file with the Secretary of State.
e.
Candidates for Garrison Conservancy and Soil Conservation district shall file with the County Auditor in their county of residence.
f.
Candidates for District Judge shall file with the Secretary of State.
g.
Candidates for county offices shall file with the County Auditor.
h.
Candidates for city offices shall file with the City Auditor.
i.
Candidates for school district offices shall file with the School Business Manager of the school district.
The Statement of Interests shall be filed at the same time a Petition/Certificate of Nomination or Certificate of Endorsement is filed.
Candidates filing a Statement of Interests for the primary election need not re-file for the general election.
Every person appointed by the Governor to a state agency, board, bureau, commission, department, or occupation or professional licensing
2.
board shall file a Statement of Interests with the Secretary of State no later than the announcement of the appointment.
Please refer to the instructions provided on page 4 of the Statement of Interest for answering specific questions before completing this form.
Please Print
Name of Candidate or Appointee
Telephone Number
Spouse's Name
Address
City
State
Zip Code
Office Which Candidate is Seeking
Position to Which Appointed
OR
ITEM A
Name of Business or Employer
PRINCIPAL OCCUPATION/SOURCE OF INCOME (Check One)
Farmer
Military
Investor or Retired
Clerical and Sales
Government Employee
Business Owner
Laborer
Professional
Craftsman
Student
Other
Spouse's Name of Business or Employer
SPOUSE'S PRINCIPAL OCCUPATION/SOURCE OF INCOME (Check One)
Farmer
Military
Investor or Retired
Clerical and Sales
Government Employee
Business Owner
Laborer
Professional
Craftsman
Student
Other
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