CAMPAIGN REGISTRATION STATEMENT STATE OF WISCONSIN ETHCF-1

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CAMPAIGN REGISTRATION STATEMENT STATE OF WISCONSIN ETHCF-1 FOR OFFICE USE ONLY IF A CANDIDATE DOES NOT FILE THIS STATEMENT BY THE DEADLINE FOR FILING NOMINATION PAPERS, THE CANDIDATE'S NAME WILL NOT BE PLACED ON THE BALLOT. NOTICE: ANY CHANGE OF INFORMATION ON THIS REGISTRATION STATEMENT MUST BE FILED WITHIN 10 DAYS. IS THIS AN AMENDMENT? D Yes D No 1. CANDIDATE AND CANDIDATE COMMITTEE INFORMATION Name of Candidate Party Affiliation Office Sought (include district or branch number) Residence Address (number and street) Primary Date Candidate Telephone Number (residence) Election Date Candidate Telephone Number (employment) Campaign Committee Name (if any) Check One: LJ Candidate Committee Candidate Email Address Campaign Committee Address (if different than above) - Number, Street, Committee Email Address Telephone Number (if different than above) Committee PIN Number (four digits - REQUIRED for all committees registered with the G.A.B.) 2. POLITICAL COMMITTEE INFORMATION (For use Party Committees, Legislative Campaign Committees, PACs, Independent Expenditure Committees, Referendum Committees, Recall Committees) Name of Committee Committee PIN Number (four digits - REQUIRED for all committees registered with the G.A.B.) Address - Number, Street, Telephone Number Committee Email Address Sponsoring Organization - Name and Complete Address Type of Committee: A. LJ Political Party Committee F3 National D State D County D Other B. U Legislative Campaign Committee - Attach Statement Required by s.l 1.0403(d), Stats. Political Party and Legislative Campaign Committees Only: This Committee has a Segregated Fund - Please provide name of fund, and name and address of financial institution; C, LJ Political Action Committee Resident Committee U Nonresident Committee D. 1 1 Independent Expenditure Committee D Resident Committee D Nonresident Committee E. LJ Referendum Committee Name of Referendum F. D Recall Committee Name of Official Subject to Recall - Attach Statement Required by s.9. t0(2)(d) D Support D Oppose Support Recall I I Oppose Recall ETHCF-1 (Rev. l/20f6) THIS FORM IS PRESCRIBED BY: WISCONSIN GOVERNMENT ACCOUNTABILITY BOARD P.O. Box 7984, Madison, WI 53707-7984 Phone: 608-26^2028) Fax: 608-264-9319 web: hlu^^lis^.^v( email: (laiu'iiisjy^^^o^

3. COMMITTEE TREASURER (Campaign finance correspondence is mailed to this address.) Treasurer's Name Telephone Number (residence) Address (number and street) Telephone Number (employment) Treasurer Email Address 4. PRINCIPAL OFFICERS OF COMMITTEE AND OTHER CUSTODIANS OF BOOKS AND ACCOUNTS Attach additional listing if necessary. FOR INDEPENDENT AND LOCAL NONPARTISAN CANDIDATES ONLY: Indicate which officers or committee members are authorized to fill a vacancy in nomination due to death of candidate by an asterisk(*), SeeWis, Stats. 8.35. NAME MAILING ADDRESS Email Address Phone # POSITION 5. DEPOSITORY INFORMATION Name offinanciat Institution Address (number and street) CERTIFICATION MAJOR PURPOSE (For PACs, Independent Expenditure Committees, and Referendum Committees ONLY) a We certify that we are an entity required to file under WIS. STAT. 11 (See: statutory definitions, 11.0101 or instructions below for details). TREASURER I,. (print full name) certify the information in this statement is true, correct and complete. Signature CANDIDATE (or recall petitioner), Treasurer, Date I, (print full name) certify the information in this statement is true, correct and complete. Signature ^^ ^^^^, Candidate/Petitioner. Date +++ EXEMPTION FROM FILING CAMPAIGN FINANCE REPORTS 11.0104 Wis. Stats. +++ You may be eligible for an exemption from filing campaign finance reports. Consult the Campaign Finance Overview for your type of committee to determine if your committee qualifies for exemption. This registrant is eligible for exemption. This registrant will not accept contributions^ make disbursements or incur obligations in an aggregate amount of more than $2,000 in a calendar year. I am aware that per statute 11.0104(2), exempt status is effective only for the calendar year it is granted, and must be renewed each year if the committee wishes to remain exempt from filing reports. This registrant is no longer eligible to claim exemption. Signature of Candidate or Treasurer Date THE INFORMATION ON THIS FORM IS REQUIRED BY 9 J0(2)(d), 11.0203, 11.0303, 11.0403, 11.0503, 11,0603, 11.0803, 11.0903, WIS. STATS. FAILURE TO PROVIDE REQUIRED INFORMATION MAY SUBJECT YOU TO THE PENALTIES OF 8.30(2), 11.1400, 11.1401, WIS. STATS.

CAMPAIGN REGISTRATION STATEMENT {ETHCF-D INSTRUCTIONS Who Must Resister When Where Candidates ReferendaY committees Recall committees no later than filing nomination papers or when they raise or spend any money on election, except those needed to open a bank account than $10,000 than $2,000 Local office or referenda" with the local clerk (town, village, city, school) State office or statewide referenda ~ with the Wisconsin Government Accountability Board For a mix of state and local offices - with the Wisconsin Government Accountability Board Party Committees Political Action* Committees (PACs) Independent}: Expenditure Committees (lecs) Party committees must register upon their inception and prior to raising or spending any funds. than $2,500 than $2,500 All Party Committees, PACs, and lecs active in either state or local contests must register at the state level, with the Wisconsin Government Accountability Board. * A PAC is only required to register if it has the major purpose of express advocacy, or spends more than 50% of its total spending in a 12-month period on express advocacy, referendum activity, or contributions to candidates, legislative campaign committees, and parties. ^ An IEC is only required to register if it has the major purpose of independent expenditures, or spends over 50% of its total spending in a 12-month period on independent expenditures and referendum activity. Y A Referendum Committee is only required to file if it has the major purpose of making expenditures to support or defeat a referendum OR more than 50% of its total spending in a 12-month period is on expenditures made to support or defeat a referendum. Cpmpletinff a Reeistration Statement Section 1: Candidate and Candidate Committee Information" Section 1 should be completed by candidate committees only. Campaign Committee Name - Any candidate that accepts a donation must have a committee. Any communication (flyers, newspaper ads, website) requires a disclaimer 'Paid for by Committee name. o If you are seeking multiple offices (town, county, school board), or plan to seek another office in the future, you may want to consider a generic committee name without the name of the office sought such as 'Friends of...', or 'Committee to Elect...'. This will allow you to keep the same committee name for various offices. o Your committee name does not have to include your last name, but including your last name makes searching for your committee easier. o Committee PIN Number: is any combination of numerical digits selected by the committee and is used for electronic signature purposes. Section 2: Non-Candidate Committee Information - Section 2 should be completed by non-candidate committees only. Committee PFN Number; is any combination of numerical digits selected by the committee and is used for electronic signature purposes. A. Political Party Committee o To use the name of one of the recognized political parties in Wisconsin -- Constitution, Democratic, Libertarian, or Republican, you must have permission from the state party.

C. Political Action Committee (PAC) o PACs may receive money from individuals or other PACs, and contribute money directly to candidates. PACs may not accept money from corporations. o Committees intending to make only independent expenditures, without contributing to or coordinating with candidate committees, should register as an Independent Expenditure Committee" see letter D below. o A resident committee is based in Wisconsin and must report all receipts and expenses. o A non-resident committee is based outside of Wisconsin and must report only expenses in Wisconsin for either local and state-level contests. D. Independent Expenditure Committee o Committees making only independent expenditures may not contribute to candidate committees directly. They also cannot coordinate with candidate committees on express advocacy - communications that explicitly urge recipients to vote for or against a candidate. These committees may accept unlimited contributions from individuals and from corporations. Section 3. Campaign Treasurer - Section 3 should be completed by all committees. Ail committees must name a treasurer. A candidate may designate any adult to serve as the committee's treasurer, or the candidate may server as his/her own treasurer. It is important that the treasurer's name, complete address, telephone number and emai! address be provided on the registration statement and be kept current. All notices and forms for campaign finance reports will be sent to this person at the address given in this section. Failure to receive notice of the filing requirement does not exempt a candidate from the requirement to file the reports. Item 4. Principal Officers of the Committee and Other Custodians of Books and Accounts (Optional) If the committee has officers or other contacts besides the treasurer, they should be listed in Item 4. For a recall committee, the recall petitioner must be included here. The Ethics Commission recommends that you provide more than one person's contact information. Item 5. Depository Information (MANDATORY) In some cases, banks may require a completed ETHCF-1 registration form to open a bank account. Your committee may register without a bank account, but the ETHCF-1 form must be amended within 10 days to report any change, including new bank account information. In general, all committees must have a campaign depository account. Please list the information for one of these two options: 1. Separate campaign account o This account may be used only for campaign funds o The bank may require an Employer Identification Number (BIN) from the IRS to open a committee account 2. Only Candidates may use a personal bank account o This is allowed only if the candidate is claiming the exemption from filing finance reports (under $2,000 of receipts, under $2,000 expenses in a calendar year) Candidates running for more than one elected office may have more than one committee and more than one campaign depository account

Certification The candidate and committee treasurer must sign the original registration statement of a candidate committee certifying that the information is true, correct, and complete. For a recall committee, the recall petitioner and the treasurer must both sign. A candidate serving as his/her own treasurer only needs to sign once. Non-candidate committees require only the treasurer's signature. Amendments to the registration may be signed by either the candidate or treasurer. If there is a change in treasurer, the new treasurer should sign. ExemptiQn_Ft'o_m_Eilmg Campaign Finance Reports All committees must file campaign finance reports, unless they check the box to claim exemption and remain within those limits. o A committee not collecting or spending more than $2,000 total in a calendar year. o Candidate committees and Party Committees must register before collecting or spending any money, but those committees may not have to file reports if they claim exemption. o PACs and lecs do not have to register until they collect or spend more than $2,500 in a calendar year. A PAC or IEC that is already registered, but will have limited activity for a calendar year, may claim exemption and would not have to file reports for that year. o A referendum committee that does not collect or spend more than $10,000 is not required to register. Because a referendum committee is unlikely to be active for multiple years, it would be rare for this type of committee to claim exemption. o A recall committee that does not collect or spend more than $2^000 is not required to register. A recall committee does not have to file reports unless it succeeds in forcing a recall election, If a committee on exempt status exceeds any of the limits listed above: o The committee must immediately file an amended ETHCF-1 with the appropriate filing officer, revoking the exempt status. o The committee must report all campaign finance activity back to the beginning of the calendar year. If a committee filed reports for the previous calendar year, and wishes to go on exempt status for the upcoming year, the committee must file a January Continuing report covering all activity through December 31. Include an updated ETHCF-1 requesting exempt status for the upcoming year. Renewmg_ Exemption Statute 11.0104(2) states that exemption is effective only for the calendar year it is granted. If a committee wishes to renew its exempt status, it must file the (ETHCF-14) or a new ETHCF-1 after 12/31 and before the closing date for the first reporting period for which it would be required to file a report. Candidates on the ballot that calendar year may claim exemption when they first register, or renew their exemption from the previous calendar year, but a candidate on the ballot that caiendar year may not claim exemption before the date of her/his election if he/she has not been on exempt status previously. See statute 11.0104(1) (b). Amending a Registration Statement When any of the information reported on the registration statement changes, the statement must be amended by filing a new ETHCF-1. The candidate or treasurer must file the new ETHCF-1 within 10 days of the change, checking the "yes" box at the top of the form to indicate that it is an amendment.