On or before the closing date for filing declarations of candidacy with the town or city clerk as provided by RSA 667:8, any candidate for delegate shall file with the town or city clerk a declaration of candidacy in substantially the following form, which shall be prepared and furnished by the secretary of state:
I, ____________________, candidate for office of delegate to the constitutional convention from District No. __________ of __________ county hereby certify that I am at least 18 years of age; that I am domiciled in ward ______________ of the city of ______________ (or town or unincorporated place of ____________) county of _______________ state of New Hampshire; that I am a voter in District No. _________ of _____________ county.