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Contents

Key takeaways

Filling out the SFN 53859 form in North Dakota requires careful attention to detail. Here are key takeaways to consider:

  • Purpose: This form is used for record and credit checks as part of the lottery retailer license application process.
  • Eligibility: It is essential for individuals applying as sole proprietors, corporate directors, partners, or general managers.
  • Personal Information: Accurate personal details, including your Social Security number, are crucial for the application.
  • Previous Names: If you have used other names, including maiden names or nicknames, you must list them on the form.
  • Residency History: The form requires you to disclose any states you have lived in over the past five years.
  • Out-of-State Checks: If you have lived outside North Dakota, additional fees and documentation may be required for record checks from those states.
  • Authorization: You must authorize the Office of Attorney General to investigate your criminal history and financial information.
  • Signature Required: Your signature confirms that the information provided is accurate and grants permission for the necessary checks.
  • Privacy Notification: Providing your Social Security number is voluntary, but not doing so may hinder your application.
  • Fees: A fee of $15 is required for the record check, and additional fees may apply for out-of-state checks.

Completing the SFN 53859 form accurately can significantly impact your application process. Ensure all information is correct to avoid delays or complications.

Document Information

Fact Name Description
Form Title Lottery Record/Credit Check
Form Number SFN 53859
Revision Date 02-25-2009
Governing Law N.D.C.C. sections 53-12-13 and 53-12-14; N.D.A.C. section 10-16-02-03
Purpose This form is used to conduct record and credit checks for lottery retailer license applications.
Submission Requirement Must be submitted with the Lottery Retailer License Application.
Fee for Record Check North Dakota: $15
Previous Residence Disclosure Applicants must disclose any state of residence outside North Dakota in the last 5 years.
Social Security Number Required for conducting criminal history and credit checks; disclosure is voluntary.
Signature Requirement The applicant must sign to authorize the investigation of their criminal and financial history.

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Dos and Don'ts

When filling out the SFN 53859 form for the North Dakota Lottery Record/Credit Check, it is essential to approach the process with care and attention. Below are seven important guidelines to follow and avoid, ensuring a smoother application experience.

  • Do type or print clearly to ensure legibility.
  • Do provide accurate information, especially regarding your name, address, and Social Security number.
  • Do include all previous names used, if applicable, to prevent delays in processing.
  • Do double-check your contact information, including home and work telephone numbers.
  • Don't leave any required fields blank; incomplete forms may be rejected.
  • Don't forget to sign and date the form, as an unsigned application will not be processed.
  • Don't submit the form without reviewing the privacy notification regarding your Social Security number.

Detailed Steps for Using Sfn 53859 North Dakota

Completing the SFN 53859 form is an essential step in the process of applying for a lottery retailer license in North Dakota. This form gathers necessary information about your identity and history, which will be used to conduct a record and credit check. Careful attention to detail is important to ensure that all information is accurate and complete.

  1. Begin by entering the control number and chain store number at the top of the form.
  2. Indicate whether you are a sole proprietor, partner, corporate director/officer, shareholder, or general manager by checking the appropriate box.
  3. Provide your business name or "doing business as" (DBA) name.
  4. Fill in your social security number and last name.
  5. Complete your first name and middle name.
  6. Enter your date of birth and place of birth (city and state).
  7. Select your sex by circling either "M" for male or "F" for female.
  8. List your current home street address, including city, state, and zip code.
  9. If you have lived at a previous home address within the last two years, provide that information as well.
  10. Answer whether you have used any other first or last names, including maiden names or nicknames. If yes, list all names used.
  11. Provide the name of your employer if it differs from your DBA business name.
  12. Include your home and work telephone numbers.
  13. Indicate whether you have lived in any state other than North Dakota in the past five years. If yes, list those states and the years you lived there.
  14. Read and understand the authorization section. Confirm that the information provided is true and correct by signing and dating the form.
  15. Finally, review the privacy act notification regarding your social security number and any associated implications for your application.

Once you have completed the form, ensure that all sections are filled out accurately. It is advisable to keep a copy for your records before submitting it along with your lottery retailer license application. This will help you track your application status and provide necessary information if requested in the future.