RSA 655:21 Form.

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