A person who, in a governmental matter, [willfully makes a false written statement that is material and that the person did not believe to be true] [intentionally creates a false impression in a written application for a pecuniary or other benefit by omitting information necessary to prevent a material statement from being misleading] [willfully submits or invites reliance on any material writing that [he] [she] knows to be forged, altered, or otherwise lacking in authenticity] [willfully submits or invites reliance on any sample, specimen, map, boundary mark, or other object that [he] [she] knows to be false in a material respect] [willfully uses a trick, scheme, or device that [he] [she] knows to be misleading in a material respect] is guilty of False Statements.

ESSENTIAL ELEMENTS OF OFFENSE

The State’s burden of proof is satisfied if the evidence shows, beyond a reasonable doubt, the following essential elements:

1)  On or about [month] [day] [year], in [County], North Dakota, the Defendant, ____________;

2)  While involved in a government matter [willfully made a false written statement, _______________, which statement was material and which the Defendant did not believe to be true] [intentionally created a false impression in a written application for a pecuniary or other benefit, _______________, by omitting information necessary to prevent a material statement therein from being misleading] [willfully submitted or invited reliance on certain material,_______________, that the Defendant knew to be forged, altered, or otherwise lacking in authenticity] [willfully submitted or invited reliance on a certain sample, specimen, map, boundary mark, or other object, _______________, that the Defendant knew to be false in a material respect] [willfully used a trick, scheme, or device, _______________, that the Defendant knew to be misleading in a material respect].

[3) The Defendant did not retract the falsification in the course of the official proceeding or matter in which it was made before it became manifest that the falsification was or would be exposed and before the falsification substantially affected the proceeding or the matter.]

DEFINITIONS

A matter is a "governmental matter" if it is within the jurisdiction of a government office or agency, or of an office, agency, or other establishment in the legislative or the judicial branch of government.  "Statement" means any representation, and includes a representation of opinion, belief, or other state of mind only if the representation clearly relates to state of mind apart from or in addition to any facts that are the subject of the representation.

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