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? Yes N 1. CANDIDATE AND CANDIDATE COMMITTEE INFORMATION Name f Candidate Party Affiliatin Office Sught (include district r branch number) Residence Address (number and street) Primary Date Candidate Telephne Number (residence) City, State and Zip Cde Electin Date Candidate Telephne Number (emplyment) Campaign Cmmittee Name (if any) Check One: Candidate Cmmittee Candidate Email Address Campaign Cmmittee Address (if different than abve) - Number, Street, City, State and Zip Cde Cmmittee Email Address Telephne Number (if different than abve) Cmmittee PIN Number (fur digits - REQUIRED fr all cmmittees registered with the G.A.B.) 2. POLITICAL COMMITTEE INFORMATION (Fr use Party Cmmittees, Legislative Campaign Cmmittees, PACs, Independent Expenditure Cmmittees, Referendum Cmmittees, Recall Cmmittees) Name f Cmmittee Cmmittee PIN Number (fur digits - REQUIRED fr all cmmittees registered with the G.A.B.) Address - Number, Street, City, State and Zip Cde Telephne Number Cmmittee Email Address Spnsring Organizatin - Name and Cmplete Address Type f Cmmittee: A. Plitical Party Cmmittee Natinal State Cunty Other B. Legislative Campaign Cmmittee Attach Statement Required by s.11.0403(d), Stats. Plitical Party and Legislative Campaign Cmmittees Only: This Cmmittee has a Segregated Fund Please prvide name f fund, and name and address f financial institutin: C. Plitical Actin Cmmittee Resident Cmmittee Nnresident Cmmittee D. Independent Expenditure Cmmittee Resident Cmmittee Nnresident Cmmittee E. Referendum Cmmittee Supprt Oppse Name f Referendum F. Recall Cmmittee Supprt Recall Oppse Recall Name f Official Subject t Recall - Attach Statement Required by s.9.10(2)(d) ETHCF-1 (Rev. 1/2016) THIS FORM IS PRESCRIBED BY: WISCONSIN GOVERNMENT ACCOUNTABILITY BOARD P.O. Bx 7984, Madisn, WI 53707-7984 Phne: 608-261-2028 Fax: 608-264-9319 web: https://cfis.wi.gv email: GABCFIS@wi.gv

3. COMMITTEE TREASURER (Campaign finance crrespndence is mailed t this address.) Treasurer s Name Telephne Number (residence) Address (number and street) Telephne Number (emplyment) City, State and Zip Cde Treasurer Email Address 4. PRINCIPAL OFFICERS OF COMMITTEE AND OTHER CUSTODIANS OF BOOKS AND ACCOUNTS Attach additinal listing if necessary. FOR INDEPENDENT AND LOCAL NONPARTISAN CANDIDATES ONLY: Indicate which fficers r cmmittee members are authrized t fill a vacancy in nminatin due t death f candidate by an asterisk(*). See Wis. Stats. 8.35. NAME MAILING ADDRESS Email Address Phne # POSITION 5. DEPOSITORY INFORMATION Name f Financial Institutin Address (number and street) City, State and Zip Cde CERTIFICATION MAJOR PURPOSE (Fr PACs, Independent Expenditure Cmmittees, and Referendum Cmmittees ONLY) We certify that we are an entity required t file under WIS. STAT. 11 (See: statutry definitins, 11.0101 r instructins belw fr details). TREASURER I, (print full name) certify the infrmatin in this statement is true, crrect and cmplete. Signature, Treasurer. CANDIDATE (r recall petitiner) Date I, (print full name) certify the infrmatin in this statement is true, crrect and cmplete. Signature, Candidate/Petitiner. Date + + + EXEMPTION FROM FILING CAMPAIGN FINANCE REPORTS 11.0104 Wis. Stats. + + + Yu may be eligible fr an exemptin frm filing campaign finance reprts. Cnsult the Campaign Finance Overview fr yur type f cmmittee t determine if yur cmmittee qualifies fr exemptin. This registrant is eligible fr exemptin. This registrant will nt accept cntributins, make disbursements r incur bligatins in an aggregate amunt f mre than $2,000 in a calendar year. I am aware that per statute 11.0104(2), exempt status is effective nly fr the calendar year it is granted, and must be renewed each year if the cmmittee wishes t remain exempt frm filing reprts. This registrant is n lnger eligible t claim exemptin. Signature f Candidate r Treasurer Date THE INFORMATION ON THIS FORM IS REQUIRED BY 9.10(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-1) INSTRUCTIONS Wh Must Register When Where Candidates ReferendaɎ cmmittees Recall cmmittees n later than filing nminatin papers r when they raise r spend any mney n electin, except thse needed t pen a bank accunt Befre spending r taking in mre than $10,000 Befre spending r taking in mre than $2,000 Lcal ffice r referenda- with the lcal clerk (twn, village, city, schl) State ffice r statewide referenda with the Wiscnsin Gvernment Accuntability Bard Fr a mix f state and lcal ffices with the Wiscnsin Gvernment Accuntability Bard Party Cmmittees Plitical Actin* Cmmittees (PACs) Independent Expenditure Cmmittees (IECs) Party cmmittees must register upn their inceptin and prir t raising r spending any funds. Befre spending r taking in mre than $2,500 Befre spending r taking in mre than $2,500 All Party Cmmittees, PACs, and IECs active in either state r lcal cntests must register at the state level, with the Wiscnsin Gvernment Accuntability Bard. * A PAC is nly required t register if it has the majr purpse f express advcacy, r spends mre than 50% f its ttal spending in a 12-mnth perid n express advcacy, referendum activity, r cntributins t candidates, legislative campaign cmmittees, and parties. An IEC is nly required t register if it has the majr purpse f independent expenditures, r spends ver 50% f its ttal spending in a 12-mnth perid n independent expenditures and referendum activity. Ɏ A Referendum Cmmittee is nly required t file if it has the majr purpse f making expenditures t supprt r defeat a referendum OR mre than 50% f its ttal spending in a 12-mnth perid is n expenditures made t supprt r defeat a referendum. Cmpleting a Registratin Statement Sectin 1: Candidate and Candidate Cmmittee Infrmatin - Sectin 1 shuld be cmpleted by candidate cmmittees nly. Campaign Cmmittee Name Any candidate that accepts a dnatin must have a cmmittee. Any cmmunicatin (flyers, newspaper ads, website) requires a disclaimer Paid fr by Cmmittee name. If yu are seeking multiple ffices (twn, cunty, schl bard), r plan t seek anther ffice in the future, yu may want t cnsider a generic cmmittee name withut the name f the ffice sught such as Friends f, r Cmmittee t Elect.. This will allw yu t keep the same cmmittee name fr varius ffices. Yur cmmittee name des nt have t include yur last name, but including yur last name makes searching fr yur cmmittee easier. Cmmittee PIN Number: is any cmbinatin f numerical digits selected by the cmmittee and is used fr electrnic signature purpses. Sectin 2: Nn-Candidate Cmmittee Infrmatin - Sectin 2 shuld be cmpleted by nn-candidate cmmittees nly. Cmmittee PIN Number: is any cmbinatin f numerical digits selected by the cmmittee and is used fr electrnic signature purpses. A. Plitical Party Cmmittee T use the name f ne f the recgnized plitical parties in Wiscnsin Cnstitutin, Demcratic, Libertarian, r Republican, yu must have permissin frm the state party.

C. Plitical Actin Cmmittee (PAC) PACs may receive mney frm individuals r ther PACs, and cntribute mney directly t candidates. PACs may nt accept mney frm crpratins. Cmmittees intending t make nly independent expenditures, withut cntributing t r crdinating with candidate cmmittees, shuld register as an Independent Expenditure Cmmittee - see letter D belw. A resident cmmittee is based in Wiscnsin and must reprt all receipts and expenses. A nn-resident cmmittee is based utside f Wiscnsin and must reprt nly expenses in Wiscnsin fr either lcal and state-level cntests. D. Independent Expenditure Cmmittee Cmmittees making nly independent expenditures may nt cntribute t candidate cmmittees directly. They als cannt crdinate with candidate cmmittees n express advcacy cmmunicatins that explicitly urge recipients t vte fr r against a candidate. These cmmittees may accept unlimited cntributins frm individuals and frm crpratins. Sectin 3. Campaign Treasurer - Sectin 3 shuld be cmpleted by all cmmittees. All cmmittees must name a treasurer. A candidate may designate any adult t serve as the cmmittee s treasurer, r the candidate may server as his/her wn treasurer. It is imprtant that the treasurer s name, cmplete address, telephne number and email address be prvided n the registratin statement and be kept current. All ntices and frms fr campaign finance reprts will be sent t this persn at the address given in this sectin. Failure t receive ntice f the filing requirement des nt exempt a candidate frm the requirement t file the reprts. Item 4. Principal Officers f the Cmmittee and Other Custdians f Bks and Accunts (Optinal) If the cmmittee has fficers r ther cntacts besides the treasurer, they shuld be listed in Item 4. Fr a recall cmmittee, the recall petitiner must be included here. The Ethics Cmmissin recmmends that yu prvide mre than ne persn s cntact infrmatin. Item 5. Depsitry Infrmatin (MANDATORY) In sme cases, banks may require a cmpleted ETHCF-1 registratin frm t pen a bank accunt. Yur cmmittee may register withut a bank accunt, but the ETHCF-1 frm must be amended within 10 days t reprt any change, including new bank accunt infrmatin. In general, all cmmittees must have a campaign depsitry accunt. Please list the infrmatin fr ne f these tw ptins: 1. Separate campaign accunt This accunt may be used nly fr campaign funds The bank may require an Emplyer Identificatin Number (EIN) frm the IRS t pen a cmmittee accunt 2. Only Candidates may use a persnal bank accunt This is allwed nly if the candidate is claiming the exemptin frm filing finance reprts (under $2,000 f receipts, under $2,000 expenses in a calendar year) Candidates running fr mre than ne elected ffice may have mre than ne cmmittee and mre than ne campaign depsitry accunt.

Certificatin The candidate and cmmittee treasurer must sign the riginal registratin statement f a candidate cmmittee certifying that the infrmatin is true, crrect, and cmplete. Fr a recall cmmittee, the recall petitiner and the treasurer must bth sign. A candidate serving as his/her wn treasurer nly needs t sign nce. Nn-candidate cmmittees require nly the treasurer s signature. Amendments t the registratin may be signed by either the candidate r treasurer. If there is a change in treasurer, the new treasurer shuld sign. Exemptin Frm Filing Campaign Finance Reprts All cmmittees must file campaign finance reprts, unless they check the bx t claim exemptin and remain within thse limits. A cmmittee nt cllecting r spending mre than $2,000 ttal in a calendar year. Candidate cmmittees and Party Cmmittees must register befre cllecting r spending any mney, but thse cmmittees may nt have t file reprts if they claim exemptin. PACs and IECs d nt have t register until they cllect r spend mre than $2,500 in a calendar year. A PAC r IEC that is already registered, but will have limited activity fr a calendar year, may claim exemptin and wuld nt have t file reprts fr that year. A referendum cmmittee that des nt cllect r spend mre than $10,000 is nt required t register. Because a referendum cmmittee is unlikely t be active fr multiple years, it wuld be rare fr this type f cmmittee t claim exemptin. A recall cmmittee that des nt cllect r spend mre than $2,000 is nt required t register. A recall cmmittee des nt have t file reprts unless it succeeds in frcing a recall electin. If a cmmittee n exempt status exceeds any f the limits listed abve: The cmmittee must immediately file an amended ETHCF-1 with the apprpriate filing fficer, revking the exempt status. The cmmittee must reprt all campaign finance activity back t the beginning f the calendar year. If a cmmittee filed reprts fr the previus calendar year, and wishes t g n exempt status fr the upcming year, the cmmittee must file a January Cntinuing reprt cvering all activity thrugh December 31 st. Include an updated ETHCF-1 requesting exempt status fr the upcming year. Renewing Exemptin Statute 11.0104(2) states that exemptin is effective nly fr the calendar year it is granted. If a cmmittee wishes t renew its exempt status, it must file the (ETHCF-14) r a new ETHCF-1 after 12/31 and befre the clsing date fr the first reprting perid fr which it wuld be required t file a reprt. Candidates n the ballt that calendar year may claim exemptin when they first register, r renew their exemptin frm the previus calendar year, but a candidate n the ballt that calendar year may nt claim exemptin befre the date f her/his electin if he/she has nt been n exempt status previusly. See statute 11.0104(1) (b). Amending a Registratin Statement When any f the infrmatin reprted n the registratin statement changes, the statement must be amended by filing a new ETHCF-1. The candidate r treasurer must file the new ETHCF-1 within 10 days f the change, checking the yes bx at the tp f the frm t indicate that it is an amendment.