Each sheet of such petition shall be signed in ink and shall be substantially in the following form:
To the Town Boards of the Towns of ................. and ............. County of ................ State of New York.
We, the undersigned, duly qualified electors of the towns of .............. and ................. respectfully petition each town board to reduce the number of justices in each town to one justice and provide for the extension of the geographic jurisdiction of such justices to include the area of such towns and also to provide for an orderly transition subject to the approval of the electors of each town as authorized by law.
Date Signature Residence ........................................................................ ........................................................................ ........................................................................ ........................................................................
Statement of Witness:
I.............state: I am over the age of eighteen years and now reside at...................(residence, address, or post office address if not identical) in the Town of.................in the State of New York, County of................Each of the electors 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. Uniform Justice Court Law § 106-A