N.Y. Elec. Law § 6-166

§ 6-166. Primary; opportunity to ballot, form of petition. 1. The form\nof a petition requesting an opportunity to write in the name of an\nundesignated candidate or undesignated candidates at a primary election\nshall conform to the requirements for a designating petition, except as\notherwise provided herein.\n 2. Each sheet of such petition shall be signed in ink and shall be\nsubstantially in the following form:\n I, the undersigned, do hereby state that I am a duly enrolled voter of\nthe .......... party and entitled to vote at the next primary election\nof such party, that my place of residence is truly stated opposite my\nsignature hereto, and I do hereby request an opportunity to write in the\nname of an undesignated candidate or candidates for nomination to the\npublic office or offices or for election to the party position or\npositions, in the political unit or units of representation hereinafter\nset forth, of such party to be voted on the .....day of .............\n20...., as hereinafter specified.\nPublic Office or party Political unit or unit of\nposition ............. representation.................\nThe appointment of a committee to receive notices, the signatures on the\npetition with all required information and the signed statement of a\nwitness or authentication by a notary public or commissioner of deeds,\nshall be in the form prescribed for a designating petition.\n