(xi) A place for the applicant to execute the form on a line which is clearly labeled "signature of applicant" preceded by the following specific form of affirmation:
AFFIDAVIT: I swear or affirm that:
* I am a citizen of the United States.
* I will have lived in the county, city, or village for at least 30
days before the election.
* I meet all the requirements to register to vote in New York State.
* This is my signature or mark on the line below.
* All the information contained on this application is true. I
understand that if it is not true I can be convicted and fined up to $5,000 and/or jailed for up to four years. which form of affirmation shall be followed by a space for the date and the aforementioned line for the applicant's signature.