§ 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
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