N.Y. Election Law § 6-204: Designating petition; form

§ 6-204. Designating petition; form. 1. Party designations for

elective village offices shall be made on a designating petition

containing the signatures in ink of residents of the village who are

registered to vote with the appropriate county board of elections at the

time of signing and who are enrolled in such political party. The sheets

of such a petition shall be numbered. A signer need not himself or

herself fill in the date or residence. Each sheet of such petition must

be in substantially the following form and shall contain all the

information required therein:

PARTY DESIGNATING PETITION

I, the undersigned do hereby state that I am a registered voter of the

Village of ............. and a duly enrolled voter of the .............

party and entitled to vote at the next primary election of such party,

that my place of residence is truly stated opposite my signature hereto,

and I hereby designate the following named person (or persons) as a

candidate or (candidates) for nomination of such party for the public

office or (public offices) to be voted for at the primary election to be

held on the ...... day of ............ 20.... as hereinafter specified.

Public Office

(include district

number,

Name of Candidate if applicable) Term Residence

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

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

I do hereby appoint (insert 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 Residence

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

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

STATEMENT OF WITNESS

I ............... (name of witness) state: I am a duly qualified voter

of the State of New York; and an enrolled voter of the ......... party.

I now reside at ..... (residence address). Each of the persons whose

names are subscribed to this petition sheet containing .........

signatures, subscribed his or her name in my presence.

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

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 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)

Page No........

2. Notwithstanding any other provision of law, the number of

signatures required on a designating petition shall be five percent of

the number of enrolled voters of the party residing in the village.