Section 6-166. Primary; opportunity to ballot, form of petition

1. The form
  of  a  petition  requesting  an  opportunity  to write in the name of an
  undesignated candidate or undesignated candidates at a primary  election
  shall  conform to the requirements for a designating petition, except as
  otherwise provided herein.
    2. Each sheet of such petition shall be signed in  ink  and  shall  be
  substantially in the following form:
    I, the undersigned, do hereby state that I am a duly enrolled voter of
  the  ..........  party and entitled to vote at the next primary election
  of such party, that my place of residence is truly  stated  opposite  my
  signature hereto, and I do hereby request an opportunity to write in the
  name  of  an  undesignated candidate or candidates for nomination to the
  public office or offices or  for  election  to  the  party  position  or
  positions,  in the political unit or units of representation hereinafter
  set forth, of such party to be voted on the  .....day  of  .............
  20...., as hereinafter specified.
  Public Office or party               Political unit or unit of
  position .............               representation.................
 
  The appointment of a committee to receive notices, the signatures on the
  petition  with  all  required  information and the signed statement of a
  witness or authentication by a notary public or commissioner  of  deeds,
  shall be in the form prescribed for a designating petition.