I, the undersigned, do hereby state that I am a duly qualified voter of the school district of the city of Rensselaer, that I was or will be registered to vote therein thirty days preceding the ensuing annual school election to which this petition pertains, that my present place of residence is truly stated opposite my signature hereto, and that I intend to support at the ensuing election, and I do hereby nominate the following named person as a candidate for nomination for the public office of member of the board of education of the school district of the city of Rensselaer to be voted for at the election to be held on the........... day of................,19.....
In witness whereof, I have hereunto set my hand the day and year placed opposite my signature.
Date Name of Signer Present Residence
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Ward Election District
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Statement of Witness
I,............................(name of witness), state: I am a duly qualified voter of the state of New York, and now reside in the city, town or village of....................., in such state, at............................(fill in street and house number and post office) therein. The said residence is in the..............(fill in number) election district of the..........................(fill in ward in a city, or town, if outside a city). I know each of the voters whose names are subscribed to this petition sheet containing (fill in number).................. signatures and each of them subscribed the same in my presence and upon so subscribing declared to me that the foregoing statement, made and subscribed by him, was true.
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Signature of witness
Date.................
N.Y. Educ. Law § 2502