N.Y. ELN Law § 6-166

§ 6-166. Primary; opportunity to ballot, form of petition. 1. The form\nof a petition requesting an opportunity to write in the name of an\nundesignated candidate or undesignated candidates at a primary election\nshall conform to the requirements for a designating petition, except as\notherwise provided herein.\n 2. Each sheet of such petition shall be signed in ink and shall be\nsubstantially in the following form:\n I, the undersigned, do hereby state that I am a duly enrolled voter of\nthe .......... party and entitled to vote at the next primary election\nof such party, that my place of residence is truly stated opposite my\nsignature hereto, and I do hereby request an opportunity to write in the\nname of an undesignated candidate or candidates enrolled in such party\nfor nomination to the public office or offices or for election to the\nparty position or positions, in the political unit or units of\nrepresentation hereinafter set forth, of such party to be voted on the\n......day of............. 20...., as hereinafter specified.\nPublic Office or party Political unit or unit of\nposition ............. representation.................\nThe appointment of a committee to receive notices, the signatures on the\npetition with all required information and the signed statement of a\nwitness or authentication by a notary public or commissioner of deeds,\nshall be in the form prescribed for a designating petition.\n 3. Individuals appointed to serve on the committee to receive notices,\nshall, in a certificate signed and acknowledged by him or her, and filed\nas provided in this article, accept the appointment of the committee,\notherwise such appointment shall be null and void. All certificates of\nacceptance shall be filed not later than the fourth day after the last\nday to file petitions for the opportunity to ballot.\n