Section 6-140. Independent nominations; form of petition

1. a. Each sheet
  of an independent nominating petition shall  be  signed  in  ink,  shall
  contain  the  following  information  and  shall be in substantially the
  following form:
    I, the undersigned, do hereby state that I am a  registered  voter  of
  the  political  unit  for which a nomination for public office is hereby
  being made, that my present place of residence is truly stated  opposite
  my  signature  hereto, and that I do hereby nominate the following named
  person (or persons) as a candidate (or as candidates)  for  election  to
  public  office (or public offices) to be voted for at the election to be
  held on the ............ day of ................,  20....,  and  that  I
  select  the name ............................ (fill in name) as the name
  of the independent body  making  the  nomination  (or  nominations)  and
  ................ (fill in emblem) as the emblem of such body.
 
                                             Place of residence
                                             (also post office
   Name of            Public                  address
   Candidate          Office                 if not identical)
   ..........         .................      ..........................
   ..........         .................      ..........................
  I do hereby appoint ............................. (here insert the names
  and addresses of at least three persons, all of whom shall be registered
  voters  within such political unit), as a committee to fill vacancies in
  accordance with the provisions of the election law.
    In witness whereof, I have hereunto set my  hand,  the  day  and  year
  placed opposite my signature.
 
   Date              Name of Signer            Residence
   ......            ................          .......................
   ......            ................          .......................
                                               Town or city (except
                                               in the city of New
                                               York, the county)
                                               .......................
                                               .......................
 
    b.  There  shall  be  appended  at  the  bottom of each sheet a signed
  statement of a witness who is a duly qualified voter of the state.  Such
  a  statement  shall be accepted for all purposes as the equivalent of an
  affidavit, and if it contains a material false statement, shall  subject
  the  person  signing  it  to the same penalties as if he or she had been
  duly sworn. The  form  of  such  statement  shall  be  substantially  as
  follows:
 
                            STATEMENT OF WITNESS
 
    I,  ......................  (name  of  witness)  state:  I  am  a duly
  qualified  voter  of  the  State  of  New  York  and   now   reside   at
  ........................................ (residence address).
    Each  of  the  individuals whose names are subscribed to this petition
  sheet containing ........ (fill in number)  signatures,  subscribed  the
  same  in my presence on the dates above indicated and identified himself
  or herself to be the individual who signed this sheet.
    I understand that this statement will be accepted for all purposes  as
  the  equivalent  of  an  affidavit  and, if it contains a material false
  statement, shall subject me to the same penalties as if I had been  duly
  sworn.

  Date: ................                  .........................
                                             Signature of Witness
    Witness identification information:
    The  following  information must be completed prior to filing with the
  board of elections in order for this petition sheet to be valid.
                        Town or City               County
                       ...............            .........
    2. In lieu of the  signed  statement  of  a  witness  who  is  a  duly
  qualified  voter  of  the  state  qualified  to  sign  the petition, the
  following statement signed by a notary public or commissioner  of  deeds
  shall be accepted:
    On  the  dates  above  indicated before me personally came each of the
  voters  whose  signatures  appear  on  this  petition  sheet  containing
  .......... (fill  in  number) signatures, who signed same in my presence
  and who, being by me duly sworn, each for himself or herself, said  that
  the foregoing statement made and subscribed by him or her, was true.
  Date: ......................
 
                                     ................................
                                     (Signature and official title
                                      of officer administering oath)
    3.  The  state  board  of  elections shall prepare a sample form of an
  independent nominating petition which meets  the  requirements  of  this
  section  and  shall  distribute or cause such forms to be distributed to
  each board of elections. Such forms  shall  be  made  available  to  the
  public  upon  request,  by  the  state  board of elections and each such
  board. Any petition that is a copy of such a sample shall be  deemed  to
  meet the requirements of form imposed by this section.