INDEPENDENT NOMINATING PETITIONSEC. 6-140.

ELECTION LAW
I, the undersigned, do hereby state that I am a registered voter of the political unit for which nomination for public office is hereby made, that my place of residence is truly stated opposite my signature hereto, and that I do hereby nominate the following named person as candidate for election to public office to be voted for at the election to be held on the 5th day of November , 2013 , and that I select the name Libertarian as the name of the Independent body making the nominations and as the emblem of such body. Name of Candidate Public Office Comptroller, New York City Place of Residence 232 East 74th Street, Apartment 4D, New York, NY 10021

Kristin M. Davis

I do hereby appoint (insert the name and address of at least three persons): Shanda Smith, 1122 Rogers Avenue, Apartment 2R, Brooklyn, NY 11226 Frank Morano, 1026 Sinclair Avenue, Staten Island, NY 10309 Vivia Morgan, 636 Brooklyn Avenue, Apartment 10J, Brooklyn, NY 11203 as a committee to fill vacancies in accordance with the provisions of the election law. IN WITNESS WHEREOF, I have signed this petition on the day and year stated opposite my signature.

DATE 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 2013 2013 2013 2013 2013 2013 2013 2013 2013 2013

SIGNATURE OF SIGNER

ADDRESS

COUNTY

STATEMENT OF WITNESS
I, (name of witness) state: I am a duly qualified voter of the State of New York. I now reside at (residence address) __________________________________________________________________________________. Each of the individuals whose names are subscribed to this petition sheet containing (fill in number) signatures, subscribed the same in my presence on the dates above indicated and identified themselves to be the individual who signed this sheet. I understand that this statement will be accepted for all purposes as the equivalent of an affidavit and, if it contains a material false statement, shall subject me to the same penalties as if I had been duly sworn. 2013 Date Signature of Witness
WITNESS IDENTIFICATION INFORMATION: The following information for the witness named above must be completed prior to filing with the Board of Elections in order for this petition sheet to be valid.

TOWN OR CITY: ____________________________________

COUNTY: ____________________________________

SHEET No. __________