§ 6-132. Designating petition; form. 1. Each sheet of a designating
petition shall be signed in ink and shall contain the following
information and shall be in substantially the following form:

I, the undersigned, do hereby state that I am a duly enrolled voter of
the.................... party and entitled to vote at the next primary
election of such party, to be held on..............., 20...; that my
place of residence is truly stated opposite my signature hereto, and I
do hereby designate the following named person (or persons) as a
candidate (or candidates) for the nomination of such party for public
office or for election to a party position of such party.

Public Office

or party position Place of Residence
Names of (include district number, (also post office address,
candidates if applicable) if not identical)
............ ................ .........................
............ ................ .........................

I do hereby appoint .............................. (insert the 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 of Signer Residence
............ .............. .........................
............ .............. .........................

Town or city (except

in the city of New

York, the county)

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

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

2. 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, who
is an enrolled voter of the same political party as the voters qualified
to sign the petition 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 am an enrolled voter of
the....................... party. I 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

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

3. 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)

4. The state board of elections shall prepare a sample form of a
designating 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.