N.Y. Election Law § 6-132: Designating petition; form

§ 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.

________________________________________________________________________

**(JOINTLY DESIGNATED CANDIDACY FOR GOVERNOR AND LIEUTENANT GOVERNOR)**

Name of Governor Residence of Candidate

Candidate for Governor

for Governor

............ .........................

............ .........................

Name of

Candidate for

Lieutenant Lieutenant Governor Residence of Candidate

Governor for Lieutenant Governor

............ .........................

............ .........................

________________________________________________________________________

Public Office

or party position Place of Residence

Names of (include district number, (also post office address,

candidates if applicable) 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, who

is an enrolled voter of the same political party as the voters qualified

to sign the petition and who has not previously signed a petition for

another candidate for the same office. 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, 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.