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.
Name of Candidate | Public Office (include district number, 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.
VILLAGE INDEPENDENT NOMINATING PETITION
I, the undersigned, do hereby state that I am a registered voter of the Village of .........., that my present place of residence is truly stated opposite my signature, and 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.
Name of Candidate | Public Office (include district number, if applicable) | Term | Residence |
.................... | ................. | ........ | ................. |
.................... | ................. | ........ | ................. |
I do hereby appoint _ _ _ _
Name | Residence |
............. | ................. |
............. | ................. |
as a committee to fill vacancies in accordance with the provisions of the election law.
IN WITNESS WHEREOF, I have signed this petition on the day and year stated before my signature.
Date | Signature | Residence |
............. | ................. | ............... |
............. | ................. | ............... |
STATEMENT OF WITNESS
I, ............... state that I am a duly qualified voter and now reside at ............. (residence address) in the Village of ........... in the State of New York in the County of ........ . Each of the voters whose names are subscribed to this petition sheet, containing ........ (fill in number) 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
N.Y. Elec. Law § 15-108