Professional Corporation Forms

To obtain verification of licensure for the purpose of forming a professional corporation, please fill out items 1-4 on the ND Secretary of State Form number SFN 13610.  Submit the form, and payment of $20 (payable to the Board of Medicine by check, money order, or cash), to the Board’s office, along with instructions on where to send or email the completed form.  The completion of SFN 13610 is also required for annual filings with the Secretary of State’s office.  You will need to annually fill out the form and pay the $20.  Please give yourself adequate time to get the form completed before your filing deadline.  The office will not fill the form out without payment.