2006 New York Code - Independent Nominations; Form Of Petition.

 
    §  6-140.  Independent nominations; form of petition. 1. a. Each sheet
  of an independent nominating petition shall  be  signed  in  ink,  shall
  contain  the  following  information  and  shall be in substantially the
  following form:
    I, the undersigned, do hereby state that I am a  registered  voter  of
  the  political  unit  for which a nomination for public office is hereby
  being made, that my present place of residence is truly stated  opposite
  my  signature  hereto, and that I do hereby nominate the following named
  person (or persons) as a candidate (or as candidates)  for  election  to
  public  office (or public offices) to be voted for at the election to be
  held on the ............ day of ................,  20....,  and  that  I
  select  the name ............................ (fill in name) as the name
  of the independent body  making  the  nomination  (or  nominations)  and
  ................ (fill in emblem) as the emblem of such body.
 
                                             Place of residence
                                             (also post office
   Name of            Public                  address
   Candidate          Office                 if not identical)
   ..........         .................      ..........................
   ..........         .................      ..........................
  I do hereby appoint ............................. (here insert the names
  and addresses of at least three persons, all of whom shall be registered
  voters  within such political unit), 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)
                                    ..........................
                                    ..........................
 
    b.  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
  who  also  is  qualified to sign the petition. 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 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 I am also duly qualified to
  sign        the        petition.       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
  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
                       ...............            .........
 
    2. 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, said that the foregoing
  statement made and subscribed by him, was true.
  Date: ................(Signature and official title of officer
                           administering oath)...........................
    3. The state board of elections shall prepare  a  sample  form  of  an
  independent  nominating  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.