Section 655:21 Form. - New Hampshire Statutes

Primary petitions shall be made in the following form:
   State of New Hampshire
County of ____________________ ss.
City (Town) of ____________________
   I do hereby join in a petition for the printing on the primary ballot of the name of __________ whose domicile is in the city (town) of __________ (ward, street, and number, if in a city), in the county of __________, for the office of __________ to be voted for on Tuesday, the __________ day of September, _____ (year), and certify that I am qualified to vote for a candidate for said office, that I am a registered member of the __________ party, and am not at this time a signer of any other similar petition for any other candidate for the above office; that my domicile is in the city (town) of __________ (ward, street, and number, if in a city), in the county of __________. I certify that to my knowledge the above-named candidate is not a candidate for incompatible offices as defined in RSA 655:10, and that he or she is not a federal employee which makes him or her ineligible to file as a candidate for this office. I further certify that I believe the above-named person is especially qualified to fill said office.
   I hereby swear, under the penalties for voting fraud set forth below, that the information above is true and correct to the best of my knowledge and belief.

____________________ Print Voter's name ____________________ Voter's Signature
   In accordance with RSA 659:34, the penalty for knowingly or purposefully providing false information when registering to vote or voting is a class A misdemeanor with a maximum sentence of imprisonment not to exceed one year and a fine not to exceed $2,000. Fraudulently registering to vote or voting is subject to a civil penalty not to exceed $5,000.

Source. 1979, 436:1. 1991, 218:3. 1998, 356:2. 2003, 289:34, eff. Sept. 1, 2003.