N.Y. Election Law § 6-140: 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.

________________________________________________________________________

**(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 Place of residence

Office (also post office

Name of (include district address

Candidate number, if applicable) 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 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 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

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

2. 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)

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.