The municipal clerk shall forthwith prepare a certificate of notice in the following form:
"This is to certify that a petition has been filed with the clerk of (insert name of municipality) requesting that a special election be called for the purpose of submitting the following question to the legal voters of (insert name of municipality).
" "Shall the (name of municipality) abandon its government under chapters 70 to 76 of the title Municipalities and Counties of the Revised Statutes (s. 40:70-1 et seq.), commonly known as the "Walsh Act", and resume the form of government under the law under which it was operating at the time when such commission form of government was adopted, subject to any amendments and supplements to said laws which have been passed in the interim?'
"An election to decide this question will be held on Tuesday the day of, 19
"Dated this day of, 19
" " Municipal Clerk.
N.J.S. § 40:76-15