N.Y. ELN. LAW § 6-132 : NY Code - Section 6-132: Designating petition; form

Search N.Y. ELN. LAW § 6-132 : NY Code - Section 6-132: Designating petition; form

1. Each sheet of a designating
  petition shall  be  signed  in  ink  and  shall  contain  the  following
  information and shall be in substantially the following form:
    I, the undersigned, do hereby state that I am a duly enrolled voter of
  the....................  party  and entitled to vote at the next primary
  election of such party, to be held  on...............,  20...;  that  my
  place  of  residence is truly stated opposite my signature hereto, and I
  do hereby designate  the  following  named  person  (or  persons)  as  a
  candidate  (or  candidates)  for the nomination of such party for public
  office or for election to a party position of such party.
                                               Place of Residence
   Names of          Public Office             (also post office address,
   candidates        or party position         if not identical)
   ............      ................          .........................
   ............      ................          .........................
    I do hereby appoint .............................. (insert  the  names
  and  addresses  of at least three persons, all of whom shall be enrolled
  voters of said party) as a committee to  fill  vacancies  in  accordance
  with the provisions of the election law.
    In  witness  whereof,  I  have  hereunto set my hand, the day and year
  placed opposite my signature.
   Date              Name of Signer            Residence
   ............      ..............            .........................
   ............      ..............            .........................
                                                 Town or city (except
                                                 in the city of New
                                                 York, the county)
                                                 ..................
                                                 ..................
    2. There shall be appended at  the  bottom  of  each  sheet  a  signed
  statement of a witness who is a duly qualified voter of the state and an
  enrolled  voter  of  the same political party as the voters qualified to
  sign the  petition,  and  who  is  also  a  resident  of  the  political
  subdivision in which the office or position is to be voted for. However,
  in  the  case of a petition for election to the party position of member
  of  the  county  committee,  residence  in  the  same  county  shall  be
  sufficient.  Such  a statement shall be accepted for all purposes as the
  equivalent of  an  affidavit,  and  if  it  contains  a  material  false
  statement,  shall subject the person signing it to the same penalties as
  if he or she had been duly sworn. The form of such  statement  shall  be
  substantially as follows:
                             STATEMENT OF WITNESS
    I,..................... (name of witness) state: I am a duly qualified
  voter   of   the  State  of  New  York  and  am  an  enrolled  voter  of
  the....................... party. I  now  reside  at....................
  (residence address).
    Each  of  the  individuals whose names are subscribed to this petition
  sheet   containing.................   (fill   in   number)   signatures,
  subscribed  the  same  in  my  presence on the dates above indicated and
  identified himself or herself to  be  the  individual  who  signed  this
  sheet.
    I  understand that this statement will be accepted for all purposes as
  the equivalent of an affidavit and, if  it  contains  a  material  false
  statement,  shall subject me to the same penalties as if I had been duly
  sworn.
    Date:.......................           ..........................
                                              Signature of Witness

    Witness identification information: The following information must  be
  completed  prior to filing with the board of elections in order for this
  petition sheet to be valid.
                     Town or City              County
                     ............             ........
    3.    In  lieu  of  the  signed  statement  of a witness who is a duly
  qualified voter of  the  state  qualified  to  sign  the  petition,  the
  following  statement  signed by a notary public or commissioner of deeds
  shall be accepted:
    On the dates above indicated before me personally  came  each  of  the
  voters  whose  signatures  appear  on  this  petition  sheet  containing
  ............. (fill  in  number)  signatures,  who  signed  same  in  my
  presence  and  who, being by me duly sworn, each for himself or herself,
  said that the foregoing statement made and subscribed by him or her, was
  true.
  Date:..................
 
                                          .............................
                                          (Signature and official title
                                          of officer administering oath)
    4. The state board of elections shall  prepare  a  sample  form  of  a
  designating  petition  which  meets the requirements of this section and
  shall distribute or cause such forms to be distributed to each board  of
  elections.  Such  forms  shall  be  made  available  to the public, upon
  request, by the state board  of  elections  and  each  such  board.  Any
  petition  that  is  a  copy of such a sample shall be deemed to meet the
  requirements of form imposed by this section.