Declarations of intent for nonparty or other candidates shall be in the following form and signed by the candidate:
I, __________ , declare that I am domiciled in Ward __________ , in the city (or town or unincorporated place) of __________ , county of __________ , state of New Hampshire, and am a registered voter herein; that I intend to be a candidate for the office of __________ to be chosen at the general election to be held on the __________ day of __________ ; and I intend to file nomination papers by the deadline established under RSA 655:43. I further declare that, if qualified as a candidate for said office, I shall not withdraw; and that, if elected, I shall be qualified for and shall assume the duties of said office. If I have been convicted of a felony, I declare that I have completed my sentence as required in RSA 607-A:2.