N.Y. Elec. Law § 6-140

§ 6-140. Independent nominations; form of petition. 1. a. Each sheet\nof an independent nominating petition shall be signed in ink, shall\ncontain the following information and shall be in substantially the\nfollowing form:\n I, the undersigned, do hereby state that I am a registered voter of\nthe political unit for which a nomination for public office is hereby\nbeing made, that my present place of residence is truly stated opposite\nmy signature hereto, and that I do hereby nominate the following named\nperson (or persons) as a candidate (or as candidates) for election to\npublic office (or public offices) to be voted for at the election to be\nheld on the ............ day of ................, 20...., and that I\nselect the name ............................ (fill in name) as the name\nof the independent body making the nomination (or nominations) and\n................. (fill in emblem) as the emblem of such body.\n________________________________________________________________________\n **(JOINTLY DESIGNATED CANDIDACY FOR GOVERNOR AND LIEUTENANT GOVERNOR)**\n Name of Governor Residence of Candidate\n Candidate for Governor\n for Governor\n ............ .........................\n ............ .........................\n Name of\n Candidate for\n Lieutenant Lieutenant Governor Residence of Candidate\n Governor for Lieutenant Governor\n ............ .........................\n ............ .........................\n________________________________________________________________________\n Public Place of residence\n Office (also post office\n Name of (include district address\n Candidate number, if applicable) if not identical)\n .......... ................. ..........................\n .......... ................. ..........................\nI do hereby appoint ............................. (here insert the names\nand addresses of at least three persons, all of whom shall be registered\nvoters within such political unit), as a committee to fill vacancies in\naccordance with the provisions of the election law.\n In witness whereof, I have hereunto set my hand, the day and year\nplaced opposite my signature.\n Date Name of Signer Residence\n ...... ................ .......................\n ...... ................ .......................\n Town or city (except\n in the city of New\n York, the county)\n .......................\n .......................\n b. There shall be appended at the bottom of each sheet a signed\nstatement of a witness who is a duly qualified voter of the state and\nwho has not previously signed a petition for another candidate for the\nsame office. Such a statement shall be accepted for all purposes as the\nequivalent of an affidavit, and if it contains a material false\nstatement, shall subject the person signing it to the same penalties as\nif he or she had been duly sworn. The form of such statement shall be\nsubstantially as follows:\n STATEMENT OF WITNESS\n I, ...................... (name of witness) state: I am a duly\nqualified voter of the State of New York and now reside at\n......................................... (residence address).\n Each of the individuals whose names are subscribed to this petition\nsheet containing ........ (fill in number) signatures, subscribed the\nsame in my presence on the dates above indicated and identified himself\nor herself to be the individual who signed this sheet.\n I understand that this statement will be accepted for all purposes as\nthe equivalent of an affidavit and, if it contains a material false\nstatement, shall subject me to the same penalties as if I had been duly\nsworn.\nDate: ................ .........................\n Signature of Witness\n Witness identification information:\n The following information must be completed prior to filing with the\nboard of elections in order for this petition sheet to be valid.\n Town or City County\n ............... .........\n 2. In lieu of the signed statement of a witness who is a duly\nqualified voter of the state, the following statement signed by a notary\npublic or commissioner of deeds shall be accepted:\n On the dates above indicated before me personally came each of the\nvoters whose signatures appear on this petition sheet containing\n........... (fill in number) signatures, who signed same in my presence\nand who, being by me duly sworn, each for himself or herself, said that\nthe foregoing statement made and subscribed by him or her, was true.\nDate: ......................\n ................................\n (Signature and official title\n of officer administering oath)\n 3. The state board of elections shall prepare a sample form of an\nindependent nominating petition which meets the requirements of this\nsection and shall distribute or cause such forms to be distributed to\neach board of elections. Such forms shall be made available to the\npublic upon request, by the state board of elections and each such\nboard. Any petition that is a copy of such a sample shall be deemed to\nmeet the requirements of form imposed by this section.\n