North Dakota Code § 31-15-05

Form of unsworn declaration
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An unsworn declaration under this chapter must be substantially in the following form:
I declare, under penalty of perjury under the law of North Dakota, that the foregoing is true 
and correct.
Signed on the _____ day of _______, _______ at ____________________, ___________
 (month) (year) (city or other location, and state) (country)
________________________________ 
 (printed name)
________________________________
 (signature)

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