N.Y. Elec. Law § 6-204
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 and now reside in the Village of ......... County of ......... State of New York at ............ (residence address) therein. 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........
N.Y. Elec. Law § 6-204