I do hereby join in a petition for the printing on the presidential primary ballot of the name of __________ whose domicile is in the city (town) of _______________ (street and number and ward if in a city) _______________, in the county of __________, state of _______________, for the office of president to be voted for on Tuesday, the __________ day of __________, 20 ___, and certify that I am qualified to vote for a candidate for said office, that I am a registered member of the __________ party, and am not at this time a signer of any other similar petition for any other candidate for the above office.
Voter's Signature Print Voter's Name Voter's Domicile street address Town or City (Ward)
Voter's Mailing Address street Town or City Zip Code
I certify that the signer above is a registered member of the __________ party and a registered voter in the town/city of _______________.
Date of Filing __________
Signature of Town (City) Clerk __________
RSA 655:48
1979, 436:1. 1983, 298:2. 1998, 246:2. 2009, 33 : 2 , eff. July 14, 2009.