I join in a petition to place on the primary ballot of the ...................... . party the name of ...................., whose residence is in the (city), (town) of ...................... in the county of ......................, for the office of ...................... to be voted for on Tuesday, the ............... day of August, 20 ....... .; and I certify that I am at the present time a registered voter and am qualified to vote for a candidate for this office.
17 V.S.A. § 2353