Cover Sheet
Designating and Independent Petitions
[Place Name of Party or Independent Body Here]
Name of Candidate
Residence Address
(Also mailing address if different)
Public Office or Party Position
(Include district number where appropriate)
Volume Number
Total Number of Volumes in Petition
The petition contains the number, or in excess of the number, of valid signatures required by Election Law.
Contact Person to Correct Deficiencies:
(Please print)
(Also mailing address if different)
Phone Fax
(Include if notice by fax desired)
(Include if notice by email desired)
I hereby authorize that any notice of any determination made by the Board of Elections be transmitted to the person
named above.
Signature of Candidate or Agent
click to sign
click to edit