Names of candidates | Public Office or party position (include district number, if applicable) | Place of Residence (also post office address, if not identical) | ||
Date | Name of Signer | Residence | ||
Town or city (except in the city of New York, the county) | |||||
Date: .................... | .............................. | |
Signature of Witness |
Town or City | County | ||
.............. | .......... |
Date:.................... | |
............................ | |
(Signature and official title of officer administering oath) |
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