State of New York)
) ss.: County of)
......... (name of witness) being duly sworn, says: I reside at .......... in the .......... of .......... (fill in residence) in the state of New York; I know each of the persons whose names are subscribed to the above sheet having ............. (fill in number) signatures; and each of them subscribed the same in my presence.
...........................
(Signature of witness.)
Sworn to before me this .... day of ............, 19.... ............................ (Official title of officer)
N.Y. Gen. Mun. Law § 703