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 (insert names and addresses of at least three persons, all of whom shall be registered voters within such village) 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 of the State of New York. I now reside at ................ (residence address). 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
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 § 6-206