Election Schedule

Election Schedule

2016 Spring Election School District Election Schedule Wisconsin Association of School Boards Supporting, Promoting and Advancing Public Education

SCHEDULE AT-A-GLANCE 2016 SPRING ELECTION NOVEMBER 2015 24 • Deadline for Publication of Type A Notice of Election DECEMBER 1 • Earliest Date for Circulation of Nomination Papers, If Required (NOTE: Nomination Papers Are Not Required in Many School Districts) 1 - Jan. 5 • Most Candidates will File Declarations of Candidacy, Campaign Finance Registrations, and Nomination Papers (If Required) during this Period 28 • Deadline for Incumbents to File Notice of Non-Candidacy (5:00 p.m.) JANUARY 2016 1 - Feb. 1 • Filing of January Continuing Report by Campaign Finance Registrants 5 • Candidate Deadline for Filing All Documents Needed to Establish Eligibility to Appear on the Ballot (5:00 p.m.) • Clerk Makes Initial Determination of Candidates' Eligibility for Ballot 11 - 18 • Continuing Report Forms Mailed to Campaign Finance Registrants 12 • Drawing of Lots for Ballot Order; Certify Nominations to County Clerk(s) • When a Primary is Required, Notice to Municipal Clerks of Primary Election 18 - 25 • If Primary Election is Being Held, Pre-Primary Election Report Forms Mailed On or Before 25 • If Primary Election is Being Held, Provide Municipal Clerk with Ballots (If Required) FEBRUARY 1 • Deadline for Filing Campaign Finance January Continuing Report 2 • If Delinquencies in Filing Continuing Report: — Notify Registrants Who Have Failed to Comply — Make List of Delinquents for Public Inspection — Notify Regarding Discrepancies — Compile Current List of All Reports and Statements 2 - 8 • Deadline for Filing Pre-Primary Election Report 2 - 16 • Reporting of Late Contributions (If Required) 9 • If Delinquencies in Filing Pre-Primary Election Report: — Notify Registrants Who Have Failed to Comply — Make List of Delinquents for Public Inspection — Notify Regarding Discrepancies — Compile Current List of All Reports and Statements 12 • Write-in Candidate Filing Deadline for Primary Election On or Before 15 • If Primary Election is Being Held, Choose Board of Canvassers 15 • Notice of Primary Election 16 • Spring Primary Election On or About 16 • Open Meetings Law Notice of Board of Canvassers Meeting(s) On or About 17 • Receipt of Election Materials and Other Related Duties

FEBRUARY (continued) On or About 17 - 23 • Canvass of Primary Returns and Written Determination of Primary Results On or About 17 - 26 • Recount Request May Be Filed On or About 22 - 26 • If Primary Election was Held, Drawing of Lots for Ballot Order On or About 22 - 26 • If Primary Election was Held, Certify Nominations to County Clerk(s) MARCH 7 - 14 • Pre-Election Report Forms Mailed 14 • Provide Municipal Clerk with Ballots (If Required) 22 - 28 • Deadline for Filing Pre-Election Report 22 - April 5 • Reporting Late Contributions (If Required) 29 • If Delinquencies in Filing Pre-Election Report: — Notify Registrants Who Have Failed to Comply — Make a List of Delinquents for Public Inspection — Notify Regarding Discrepancies — Compile a Current List of All Reports and Statements APRIL 1 • Write-in Candidate Filing Deadline for Spring Election On or Before 4 • Choose Board of Canvassers 4 • Notice of Spring Election 5 • Spring Election On or About 5 • Open Meetings Law Notice of Board of Canvassers Meeting(s) After 5 • Filing Campaign Finance Termination or Suspension Report On or About 6 • Receipt of Election Materials and Other Related Duties 6 - 12 • Canvass of Election Returns and Written Determination of Election Results On or About 6 - 15 • Recount Request May Be Filed On or About 11 - 15 • Certificate(s) of Election On or Before 25 • Filing of Official Oath 25 • School Board Members Take Office 25 - May 25 • Election of School Board Officials (i.e. Board Officers) JUNE 29 - July 6 • Continuing Report Forms Mailed to Campaign Finance Registrants JULY 1 - 20 • Filing of July Continuing Report by Campaign Finance Registrants 21 • If Delinquencies in Filing Continuing Report: — Notify Registrants Who Have Failed to Comply — Make a List of Delinquents for Public Inspection — Notify Regarding Discrepancies — Compile a Current List of All Reports and Statements

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BALLOT ACCESS CHECKLIST FOR 2016 SCHOOL DISTRICT CANDIDATES Each of the following forms must be completed and filed on time by candidates for school district office in order for the candidate's name to be placed on the ballot at the February 16, 2016 Spring Primary and the April 5, 2016 Spring Election. The filing officer for school district offices is the school district clerk. Candidates should contact their filing officer for further information or to obtain any of the necessary forms. All school district candidates must: ˆ ˆ Complete and submit a Campaign Registration Statement (Form GAB-1) to the filing officer no later than 5:00 p.m. on Tuesday, January 5, 2016. ¾ New candidates should file a campaign registration statement as soon as intent to seek elective office is known and before funds are collected or spent Wis. Stat. §§ 11.05(2g), 11.10(1).

¾ Continuing candidates should file an amended campaign registration statement indicating the office sought and the new primary and election dates. ¾ All candidates should file a campaign registration statement or amended statement before circulating nomination papers. A current form must be filed with the filing officer by January 5, 2016, or the candidate's name will not be placed on the ballot. Wis. Stat. §§ 8.10(5), 8.30(2). Complete and submit a Declaration of Candidacy (Form GAB-162SD) to the filing officer no later than 5 p.m. on Tuesday, January 5, 2016. If this form is not filed with the filing officer by January 5, 2016, the candidate's name will not be placed on the ballot. If the form is faxed or emailed, the original document must follow, postmarked no later than January 5, 2016. Wis. Stat. §§ 8.10(5), 8.21, 8.30(4), 120.06(6)(b), Wis. Admin. Code GAB § 6.04.

If nomination papers are used, a school district candidate must also: ˆ Circulate and obtain sufficient nomination paper signatures on form GAB-169, and submit them to the filing officer no later than 5:00 p.m. on Tuesday, January 5, 2016.. Nomination papers may not be circulated before December 1, 2015. Only original nomination papers will be accepted (no photocopies, faxes, or emailed documents). If nomination papers are not filed with the school district clerk (where required) by January 5, 2016, the candidate's name will not be placed on the ballot. Wis. Stat. §§ 8.10(2), 120.06(6)(b), Wis. Admin. Code GAB § 6.04(2).

Note: All candidates should file a Campaign Registration Statement (Form GAB-1) or amended statement before circulating nomination papers. The number of signatures required on nomination papers is as follows: Board of school directors - 1st class cities 400 - 800 School district officer - with territory within a 2nd class city 100 - 200 School district officer - with no territory within a 1st or 2nd class city 20 - 100 GABIS-5 | Rev 2015-06 | Government Accountability Board, P.O. Box 7984, Madison, WI 53707-7984 | 608-261-2028 | web: gab.wi.gov | email: gab@wi.gov

CAMPAIGN FINANCE CHECKLIST FOR 2016 MUNICIPAL AND SCHOOL DISTRICT CANDIDATES Candidates should determine if they are required to make financial disclosure reports. For Milwaukee City offices, the filing officer is the Milwaukee City Board of Election Commissioners. For all other municipal offices the filing officer is the municipal clerk. For school district offices, the filing officer is the school district clerk. Candidates should contact their filing officer for further information or to obtain any of the necessary forms. If NOT eligible for exemption from reporting requirements: ˆ ˆ ˆ ˆ Obtain a copy of the Campaign Finance Overview – Local Candidates Manual from your filing officer and carefully review it with your treasurer. ˆ ˆ ˆ ˆ Complete and submit a January Continuing Campaign Finance Report (Form     GAB-2L) to the filing officer no later than February 1, 2016, if registered before January 1, 2016. This report covers activity from July 1, 2015, or the date of registration (whichever is later), through December 31, 2015. Wis. Stat. § 11.20(4). ˆ ˆ ˆ ˆ Complete and submit a Pre-Primary Campaign Finance Report (Form GAB-2L)     to the filing officer no later than February 8, 2016, if a primary is held. This report covers activity from January 1, 2016, through February 1, 2016. ˆ ˆ ˆ ˆ Complete and submit a Pre-Election Campaign Finance Report (Form GAB-2L) to the filing officer, no later than March 28, 2016. This report covers activity from February 2, 2016, through March 21, 2016, if a primary is held, or January 1, 2016, through March 21, 2016, if no primary is held.

ˆ ˆ ˆ ˆ Complete and submit a July Continuing Campaign Finance Report (Form GAB-2L) to     the filing officer no later than July 20, 2016. This report covers activity from March 22, 2016, through June 30, 2016. Committees must file “Continuing Reports” until a termination report (GAB-2L) is filed. For further information or to obtain any of the necessary forms, please contact the Government Accountability Board. GABIS-8 | Rev 2015-06 | Government Accountability Board, P.O. Box 7984, Madison, WI 53707-7984 | 608-261-2028 | web: gab.wi.gov | email: gab@wi.gov

CAMPAIGN REGISTRATION STATEMENT STATE OF WISCONSIN FOR OFFICE USE ONLY GAB-1 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 † 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) City, State and Zip Code Election Date Candidate Telephone Number (employment) Campaign Committee Name (if any) Check One: † Personal Campaign Committee † Support Committee Candidate Email Address Campaign Committee Address (if different than above) - Number, Street, City, State and Zip Code Committee Email Address Telephone Number (if different than above) 2. POLITICAL COMMITTEE INFORMATION (For use ONLY by Political Action Committees, Political Party Committees, Political Groups, etc.) Name of Committee Address - Number, Street, City, State and Zip Code Telephone Number Committee Email Address Sponsoring Organization - Name and Complete Address Acronym (if any) Type of Committee: A. † Special Interest Committee (PAC) † Resident Committee † Nonresident Committee – (Must also file GAB-40 with WI Secretary of State’s Office) † Incorporated Labor Organization - Attach Information Required by s.11.05(3)(n), Stats. B. † Political Party Committee † National † State † County † Other _ _ C. † Legislative Campaign Committee – Attach Statement Required by s.11.05(3)(o), Stats. D. † Political Group (Referendum † Support † Oppose Name of Referendum E. † Recall Committee † Support Recall † Oppose Recall Name of Officer Subject to Recall - Attach Statement Required by s.9.10(2)(d) F. † Independent Disbursement Committee - Also, Complete Oath of Independent Expenditures, Form GAB-6 G. † Individual - Also, Complete Oath of Independent Expenditures, Form GAB-6 GAB-1 (Rev. 4/2014) THIS FORM IS PRESCRIBED BY: WISCONSIN GOVERNMENT ACCOUNTABILITY BOARD P.O. Box 7984, Madison, WI 53707-7984 Phone: 608-261-2028 | Fax: 608-264-9319 | web: https://cfis.wi.gov | email: GABCFIS@wi.gov

3. COMMITTEE TREASURER (Campaign finance correspondence is mailed to this address.) Treasurer’s Name Telephone Number (residence) Address (number and street) Telephone Number (employment) City, State and Zip Code Treasurer Email Address 4. PRINCIPAL OFFICERS OF COMMITTEE AND OTHER CUSTODIANS OF BOOKS AND ACCOUNTS Attach additional listing if necessary. Indicate which officers or committee members are authorized to fill a vacancy in nomination due to death of candidate by an asterisk(*). This provision only applies to independent and local nonpartisan candidates. s.8.35, Stats.

NAME MAILING ADDRESS Email Address Phone # POSITION 5. DEPOSITORY INFORMATION Name of Financial Institution Account Number (Attach list of any additional accounts and deposit boxes, location, type and number, i.e., savings, checking, money market, etc.) Address (number and street) City, State and Zip Code CERTIFICATION TREASURER I ( print full name) certify the information in this statement is true, correct and complete. Signature , Treasurer _ _ Date CANDIDATE (or recall petitioner) I _ ( print full name) certify the information in this statement is true, correct and complete, and that this is the only committee authorized to act on my behalf. Signature , Candidate/Petitioner _ _ Date + EXEMPTION FROM FILING CAMPAIGN FINANCE REPORTS §11.05(2r), Wis. Stats + You may be eligible for an exemption from filing campaign finance reports. Consult the Campaign Finance Instruction and Bookkeeping Manual to determine if the registrant 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 $1,000 in a calendar year or accept any contribution or cumulative contributions of more than $100 from a single source during the calendar year, except contributions by a candidate to his or her campaign of $1,000 or less in a calendar year. † This registrant is no longer eligible to claim exemption. _ _ Signature of Candidate or Treasurer Date THE INFORMATION ON THIS FORM IS REQUIRED BY §§9.10(2)(d), 11.05, 11.06(7), WIS. STATS. FAILURE TO PROVIDE THE INFORMATION MAY SUBJECT YOU TO THE PENALTIES OF §§8.30(2), 11.60, 11.61, 11.66, WIS. STATS.

CAMPAIGN REGISTRATION STATEMENT (GAB-1) INSTRUCTIONS Who Must Register When Where Candidates As soon as they form the intent to run for office. Prior to raising or spending any funds, beyond those needed to open a bank account Local office or referenda- with the local clerk (town, village, city, school) State office or statewide referenda – with the Government Accountability Board For a mix of state and local offices – with the Government Accountability Board Non-candidate committees Before spending or taking in more than $300 Referenda committees Before spending or taking in more than $2,500 Completing a Registration Statement Section 1: Candidate and Candidate Committee Information - Section 1 should be completed by candidate committees only. x 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, individual name, treasurer’.

o Candidates are only allowed one active committee for all state and local offices sought. 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.

Section 2: Non-Candidate Committee Information - Section 2 should be completed by non-candidate committees only. x A. Special Interest 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, including LLCs. o Committees intending to make only independent disbursements, without contributing to or coordinating with candidate committees, should register as an Independent Disbursement committee, letter F 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 receipts from Wisconsin residents and expenses in Wisconsin state-level contests. A non-resident committee does not have to report cash balances. A non-resident committee must also file a GAB-40 form with the Wisconsin Secretary of State.

x B. 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.

x F. Independent Disbursement Committee o Committees making only independent disbursements may not contribute to or coordinate with candidate committees. These committees may accept unlimited contributions from individuals and from corporations. Before spending any money for or against a candidate, an Independent Disbursement committee must file a notarized GAB-6 Oath of Independent Disbursement stating whether they support or oppose the candidate. Section 3. Campaign Treasurer - Section 3 should be completed by all committees. All committees must name a treasurer. A Candidate may designate any elector to serve as their treasurer, or the candidate may server as his/her own treasurer. It is important that the treasurer’s name, complete address, telephone number and email 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 G.A.B. recommends that you provide more than one person’s contact information. Item 5. Depository Information (MANDATORY) In some cases, banks may require a completed GAB-1 registration form to open a bank account. Your committee may register without a bank account, but the GAB-1 form must be amended within 10 days to report any change, including a new bank account number. Failure to provide depository information within 5 business days of the first donation and before making any disbursements may disqualify a candidate for ballot placement. (Wis. Stats. §11.10(1)) In general, all committees must have and provide a campaign depository account number. One of three things must be entered here: 1. Separate Campaign bank account o This account may be used only for campaign funds o The bank may require an Employer Identification Number (EIN) 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 $1,000 of receipts, under $1,000 expenses, no more than $100 from a single source) 3. Only Candidates are allowed to not have a bank account, but only if: o The candidate will receive no contributions and make no disbursements. No communications may be authorized or distributed. This includes in-kind contributions and expenses. o The candidate must claim exemption by checking the appropriate box on this form. o The candidate should add a hand-written statement to the form that he or she will spend no money. Candidates running for more than one elected office are only allowed one campaign depository account. All contributions and all disbursements for all offices must be run through the one account.

Certification The candidate and committee treasurer must sign the original registration statement of a personal campaign committee or a support committee certifying that the information is true, correct, and complete, and that the committee is the only committee authorized to act on the candidate’s behalf. 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.

Exemption From Filing 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 non-candidate committee may not accept more than $100 from any single source (individual or committee) in one calendar year. o A candidate committee may not accept more than $100 from any other single source (individual or committee) in a calendar year. The candidate may contribute up to $1000 to their own committee. o A committee may not spend more than $1000 total in a calendar year. o A referenda committee that does not accept contributions, make disbursements, or incur obligations of more than $2,500 is not required to register or file campaign finance reports. Referenda committees over this threshold may not claim exemption – they must register and file all required reports. If a committee on exempt status exceeds any of the limits listed above: o The committee must immediately file an amended GAB-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. Any reports past their deadline that were not filed should be filed as soon as possible. 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 31st . Include an updated GAB-1 requesting exempt status for the upcoming year. Amending a Registration Statement When any of the information reported on the registration statement changes the statement must be amended by filing a new GAB-1. The candidate or treasurer must file the new GAB-1 within 10 days of the change, checking the “yes” box at the top of the form to indicate that it is an amendment.

} Declaration of Candidacy School Board Candidates (See instructions for preparation on back) Is this an amendment? †Yes (if you have already filed a DOC for this election) †No (if this is the first DOC you have filed for this election) I , being duly sworn, state that Candidate's name I am a candidate for the office of School Board Member _ , Include seat number or name of apportioned area, if applicable and, at the time of filing this document, I will meet the applicable age, citizenship, residency and voting qualification requirements, if any, prescribed by the constitutions and laws of the United States and the State of Wisconsin, and that I will otherwise qualify for office, if nominated and elected.

I have not been convicted of a felony in any court within the United States for which I have not been pardoned.1 My present address, including my municipality of residence for voting purposes is: Town of † Village of † City of † House or fire no. Street Name Mailing Municipality and State Zip code Municipality of Residence for Voting My name as I wish it to appear on the official ballot is as follows: _ _ (Any combination of first name, middle name or initials with surname. A nickname may replace a legal name.) (Signature of candidate) STATE OF WISCONSIN County of _ _ (County of notarization) Subscribed and sworn to before me this _ _ day of _ . _ _ (Signature of person authorized to administer oaths) My commission expires or † is permanent. † Notary Public or _ _ (Official title, if not a notary) The information on this form is required by Wis. Stat. § 8.21, Stats., Art. XIII, Sec. 3, Wis. Const., and must be filed with the filing officer in order to have a candidate's name placed on the ballot. Wis. Stats. §§8.05 (1)(j), 8.10 (5), 8.15 (4)(b), 8.17 (2), 8.20 (6), 120.06 (6)(b).

GAB-162SD For School District Candidates | 2013-09 | Government Accountability Board, P.O. Box 7984, Madison, WI 53707-7984 | 608-261-2028 | web: gab.wi.gov | email: gab@wi.gov 1 A 1996 constitutional amendment bars any candidate convicted of a misdemeanor which violates the public trust from running for or holding a public office. However, the legislature has not defined which misdemeanors violate the public trust. A candidate convicted of any misdemeanor is not barred from running for or holding a public office until the legislature defines which misdemeanors apply. FOR OFFICE USE ONLY NOTARY SEAL NOT REQUIRED ss.

Instructions for Completing the Declaration of Candidacy All candidates seeking ballot status for election to school district office in the State of Wisconsin must properly complete and file a Declaration of Candidacy. This form must be ON FILE with the proper school district clerk no later than the deadline for filing nomination papers or the candidate's name will not appear on the ballot. A facsimile will be accepted if the FAX copy is received by the school district clerk no later than the filing deadline and the signed original declaration is received by the school district clerk with a postmark no later than the filing deadline.

Information to be provided by the candidate: ¾ Type or print your name on the first line. ¾ The title of the office and any seat number or apportioned district for which you are seeking election must be inserted on the second line. ¾ Felony convictions: Your name cannot appear on the ballot if you have been convicted of a felony in any court in the United States for which you have not been pardoned. Please see footnote on page 1 for further information with respect to convictions for misdemeanors involving a violation of public trust. These restrictions only apply to candidates for state and local office. ¾ Your current address, including your municipality of residence for voting purposes, must be inserted on the fourth line. This must include your entire mailing address (street and number, municipality where you receive mail) and the name of the municipality in which you reside and vote (town, village, or city of __). If your address changes before the election, an amended Declaration of Candidacy must be filed with the School District Clerk. Wis. Stat. §.8.21.

¾ Type or print your name on the fifth line as you want it to be printed on the official ballot. You may use your full legal name, or any combination of first name, middle name, and initials, or nickname with last name. Note: The Government Accountability Board has determined that, absent any evidence of an attempt to manipulate the electoral process, candidates are permitted to choose any form of their name, including nicknames, by which they want to appear on the ballot. No titles are permitted. In addition, names such as “Red” or “Skip” are permitted, but names which have an apparent electoral purpose or benefit, such as “Lower taxes,” “None of the above” or “Lower Spending” are not permitted. It is also not permissible to add nicknames in quotes or parentheses between first and last names. For example, John “Jack” Jones or John (Jack) Jones are not acceptable, but John Jones, Jack Jones or John Jack Jones are acceptable.

This form must be sworn to and signed in the presence of a notary public or other person authorized to administer oaths, such as a county, municipal or school district clerk. Wis. Stat. § 8.21(2). Information to be provided by the person administering the oath: ¾ The county of notarization. ¾ The date the Declaration of Candidacy was signed and the oath administered. ¾ The signature and title of the person administering the oath. If signed by a notary public, the date the notary’s commission expires must be listed. The notary seal is not required. All school district candidates must file this form with the appropriate school district clerk no later than the deadline for filing nomination papers. Wis. Stats. §§ 8.10 (5), 8.15 (4)(b), 8.17 (2), 8.20 (6), 8.50 (3)(a), 120.06 (6)(b).

N OMINATION P APER FOR N ONPARTISAN O FFICE  Candidate'sname;notitlesmaybeused. Street,fire,orruralroutenumber;boxnumber(ifruralroute);andname ofstreetorroad Nameofmunicipalityforvotingpurposes ‰  Town ‰Village _  ‰City  ( nameofmunicipality) Nameofmunicipalityformailingpurposes State WI zipcode Typeofelection ‰spring ‰ special  Electiondate Titleofoffice Branch,districtorseatnumber ‰  Branch ‰District ‰Seat Nameofjurisdictionordistrictinwhichcandidateseeksoffice I,theundersigned,requestthatthecandidate,whosenameandaddressare listedabove,beplacedontheballotattheelectiondescribedaboveasa candidatesothatvoterswillhavetheopportunity tovotefor‰himor‰herfortheofficelistedabove.Iameligibletov oteinthejurisdictionordistrictinwhichthecandidatenamedaboveseek soffice.Ihavenotsignedthenominationpaperofany othercandidateforthesameofficeatthiselection. Themunicipalityusedformailingpurposes,whendifferentthanmunicipalit yofresidence,isnotsufficient.Thenameofthemunicipalityofresiden cemustalwaysbelisted. SignaturesofElectors PrintedNameofElectors StreetandNumberorRuralRoute Ruraladdressmustalsoincludeboxorfireno MunicipalityofResidence Providenameofmunicipality DateofSigning 1.  ‰  Town ‰ Village ‰ City    2. ‰  Town ‰ Village ‰ City  3. ‰  Town ‰ Village ‰ City  4. ‰  Town ‰ Village ‰ City  5. ‰  Town ‰ Village ‰ City  6. ‰  Town ‰ Village ‰ City 7. ‰  Town ‰ Village ‰ City  8. ‰  Town ‰ Village ‰ City  9. ‰  Town ‰ Village ‰ City 10.   ‰  Town ‰ Village ‰ City        C ERTIFICATIONOF C IRCULATOR  I _ _ certify:Iresideat _ .

   (Nameofcirculator)        ( Circulator'sresidenceͲIncludenumber,street,andmunicipality.) IfurthercertifyIameitheraqualifiedelectorofWisconsin,oraU.S.c itizen,age18orolderwho,ifIwerearesidentofthisstate,wouldnot bedisqualifiedfromvotingunderWis.Stat. §6.03.Ipersonally circulatedthisnominationpaperandpersonallyobtainedeachofthesignat uresonthispaper.Iknowthatthesignersareelectorsofthejurisdicti onordistrictthecandidateseekstorepresent.Iknowthat eachpersonsignedthepaperwithfullknowledgeofitscontentonthedate indicatedoppositehisorhername.Iknowtheirrespectiveresidencesgi ven.Iintendtosupportthiscandidate.Iamawarethat falsifyingthiscertificationispunishableunderWis.Stat.§12.13(3)(a).  _      _    (Date)   (Signatureofcirculator) GABͲ169|Rev.2014Ͳ04|GovernmentAccountabilityBoard,P.O.Box7984,Ma dison,WI53707Ͳ7984|608Ͳ261Ͳ2028|web:gab.wi.gov|email:gab@wi.gov Page No.

I NSTRUCTIONSFOR P REPARING N OMINATION P APERSFOR N ONPARTISAN O FFICE  Thisisasamplenominationpaperform.Itconformstothestatutoryrequi rementsfornominationpapersfornonpartisanoffice.Allinformationconc erningthecandidatemustbecompletedinfull beforecirculatingthisformtoobtainsignaturesofelectors.Allinforma tionconcerningthesigningelectorsandthecirculatormustbecompletedi nfullbeforefilingwiththeappropriatefilingofficer. Thisformmaybereproducedinanyway.Acandidate'spictureandbiograph icaldatamayalsobeaddedtothisform.TheGovernmentAccountabilityBo ardhasdeterminedthatnodisclaimeror otherattributionstatementisrequiredonnominationpapers.Candidatesa readvisedtosendasampleoftheircompletedformthefilingofficerfor reviewbeforecirculation.  PageNumbers –Numbereachpageconsecutively,beginningwith“1”,beforesubmittingto thefilingofficer.Aspaceforpagenumbershasbeenprovidedinthelow errightͲhandcorneroftheform. Candidate'sName  ͲInsertthecandidate'sname.Acandidatemayusehisorherfulllegaln ame,oranycombinationoffirstname,middlename,andinitialsornicknam ewithlastname.The GovernmentAccountabilityBoardhasdeterminedthat,absentanyevidenceof anattempttomanipulatetheelectoralprocess,candidatesarepermittedt ochooseanyformoftheirname,including nicknames,bywhichtheywanttoappearontheballot. Notitlesarepermitted.Inaddition,namessuchas“Red”or“Skip”arepe rmitted,butnameswhichhaveanapparentelectoralpurposeorbenefit,suc has“Lowertaxes,”“Noneoftheabove”or “LowerSpending”arenotpermitted.Itisalsonotpermissibletoaddnick namesinquotesorparenthesesbetweenfirstandlastnames.Forexample, John“Jack”JonesorJohn(Jack)Jonesarenot acceptable,butJohnJones,JackJonesorJohnJackJonesareacceptable. Candidate'sResidence ͲIfacandidate'smunicipalityofresidenceisdifferentfromthemunicip alityusedformailingpurposes,bothmustbegiven.Indicateifthemunic ipalityofresidenceisa town,village,orcity. DateofElection ͲInsertthedateoftheelection.Ifthenominationpaperisbeingcircu latedforaspringelection,thedateisthefirstTuesdayinApril.Ifth eelectionisaspecialnonpartisan election,thedateofthespecialelectionmustbelisted. TitleofOffice ͲThenameoftheofficemustbelistedalongwithanybranch,district,o rseatnumberthatclearlyidentifiestheofficethecandidateisseeking. Ifnecessary,thenameofthe jurisdictionthatidentifiestheoffice,suchasDaneCountyCircuitCourt Judge,Branch3,mustalsobelisted. NameofJurisdiction ͲThenominationpapersmustalsoindicatethemunicipalityorjurisdictio ninwhichthesigningelectorsarequalifiedtovote,asitrelatestothe officesoughtbythecandidate namedonthenominationpaper.Forexample,forastatewideofficethejur isdictionistheStateofWisconsin.Othersmaybethecounty,town,villa ge,city,aldermanicdistrict,schooldistrict,ortown sanitarydistrict,asrequired. SignaturesandPrintedNameofElectors ͲOnlyqualifiedelectorsofthejurisdictionorthedistrictthecandidat eseekstorepresentmaysignthenominationpapers.Eachsignermustalso  legiblyprinttheirname.Eachelector'smunicipalityofresidencemustbe listedonthenominationpaperalongwiththemailingaddress,includingan ystreet,fireorruralroutenumber,boxnumber(if ruralroute)andstreetorroadname.TheStreet&NumberorRuralRoutes ectionforeachelector’saddressissplitintotwolines.Thefirstline isforthestreetaddress.Thesecondlineisforthe municipalityformailingpurposes.TheMunicipalityofResidencelistedfo reachsigningelectormustclearlyidentifythetown,villageorcitywher etheelector'svotingresidenceislocated.Apost officeboxnumberalonedoesnotshowwheretheelectoractuallyresides. Thedatetheelectorsignedthenominationpaper,includingmonth,dayand year,mustbeindicated.Dittomarksthat followcorrectandcompleteaddressordateinformationareacceptable.Th ecirculatormayaddanymissingorillegibleaddressordateinformationb eforethepapersarefiledwiththefilingofficer. SignatureofCirculator ͲThecirculatorshouldcarefullyreadthelanguageoftheCertificationo fCirculator.T HECIRCULATORMUSTPERSONALLYPRESENTTHENOMINATIONPAPERTOEACHSIGNER .

 T HENOMINATION PAPERMAYNOTBELEFTUNATTENDEDONCOUNTERSORPOSTEDONBULLETINBOARDS .Thecirculator'scompleteaddress(includingmunicipalityofresidence) mustbelistedinthecertification.Afterobtaining signaturesofelectors,thecirculatormustsignanddatethecertification . OtherInstructions ͲCandidatesandcirculatorsshouldreviewCh.GAB§§2.05,2.07,Wis.Adm .Code. ¾ Originalnominationpapersmustbeinthephysicalcustodyoftheappropria tefilingofficerbythefilingdeadline.Apostmarkonthefilingdeadlin eis NOT sufficient.Nominationpapers CANNOT befaxedtothefilingofficer.Ch.GAB§6.04(2),Wis.Adm.Code. ¾ Nominationpaperswiththerequirednumberofsignaturesmustbefiledwith theappropriatefilingofficernolaterthan5:00p.m.onthefirstTuesda yinJanuary(orthenextdayifthefirst Tuesdayisaholiday)beforethespringelection.Specialelectionsmayha vedifferentfilingdeadlines.Checkwiththefilingofficer. ¾ Inorderforacandidate'snametobeplacedontheballot,acandidatemus tfileaCampaignRegistrationStatement(GABͲ1),aDeclarationofCandidac y(GABͲ162),andNominationPapers (GABͲ169)containingtheappropriatenumberofsignaturesfortheofficeso ughtnolaterthanthefilingdeadline.Wis.Stat.§8.10(3).Candidates forstateofficeandmunicipaljudgemust alsofileastatementofeconomicinterestswiththeGovernmentAccountabil ityBoardbythethirdbusinessdayafterthenominationpaperfilingdeadl ine.Wis.Stat.§19.43.Ifanyoneof theserequiredformsisnotfiledbythedeadline,thecandidate'snamewil lnotbeplacedontheballot.Wis.Stat.§8.30. ¾ Ifacandidateorcirculatorhasanyquestions,heorsheshouldcontactth efilingofficer.

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CAMPAIGN FINANCE REPORT LOCAL COMMITTEES OF WISCONSIN Is This Report an Amendment: Yes No Instructions for completing schedules are on the back of each schedule. COMMITTEE IDENTIFICATION Name of Committee Street Address OFFICE USE ONLY City, State and Zip Code Please check if address is different than previously reported, and complete the Campaign Registration Statement in the back of this form. NAME OF REPORT January Continuing _ Pre-Primary _ Spring Fall Special Termination Report July Continuing _ Pre-Election _ Spring Fall Special also complete Schedule 4 SUMMARY OF RECEIPTS AND DISBURSEMENTS Column A This Period Column B Calendar 1. RECEIPTS Year-To-Date 1A. Contributions (Including Loans) from Individuals $ $ 1B. Contributions from Committees (Transfers-In) $ $ 1C. Other Income and Commercial Loans $ $ TOTAL RECEIPTS (Add totals from 1A, 1B and 1C) $ $ 2. DISBURSEMENTS 2A. Gross Expenditures $ $ 2B. Contributions to Committees (Transfers-Out) $ $ TOTAL DISBURSEMENTS (Add totals from 2A and 2B) $ $ CASH SUMMARY Cash Balance Beginning of Report $ Total Receipts $ Subtotal $ Total Disbursements $ CASH BALANCE END OF REPORT $ INCURRED OBLIGATIONS (Balance at the Close of This Period-3A) $ LOANS (Balance at the Close of This Period-3B) $ I certify that I have examined this report and to the best of my knowledge and belief it is true, correct and complete. Type or Print Name of Candidate or Treasurer Signature of Candidate or Treasurer Date: Email Daytime Phone: NOTE: The information on this form is required by ss.11.06, 11.20, Wis. Stats. Failure to provide the information may subject you to the penalties of ss.11.60, 11.61, Wis. Stats.

GAB-2L (Rev. 04/14) This form is prescribed by the Government Accountability Board. Completed forms must be filed with your local clerk.

Instructions for Completing Summary Page of Form GAB-2 Instructions for Completing Schedules are on the Back of Each Schedule Committee Identification ɱ Print or type the complete name and mailing address of your committee. ɱ If the report is an amendment to a previous report filed, check the “yes” box. If the report is NOT an amendment, check the “no” box. Name of Report ɱ Check the box next to the name of the report being filed, and enter the correct calendar year. For information concerning filing dates and report names, refer to the CFIS website – https://cfis.wi.gov. . Summary of Receipts and Disbursements ɱ Committees should complete the detailed pages in Schedules 1-A through 3-B before completing this summary section of the report form.

Receipts 1A. Contributions (Including Loans) From Individuals: Enter the amount of Total Contributions from Individuals (Schedule 1-A) in Column A of the Summary page. Add the amount entered in Column A to contributions previously reported for this calendar year, if any, and enter the amount in Column B, Calendar Year-to-Date. 1B.Contributions From Committees (Transfers-In): Enter the amount from Total Contributions (Transfers-In) Received From Committees (Schedule 1-B) in Column A of the Summary page. Add the amount entered in Column A to contributions previously reported for this calendar year, if any, and enter the amount in Column B, Calendar Year-to-Date. 1C.Other Income and Commercial Loans: Enter the amount of Total Other Income (Schedule 1-C) in Column A. Add the amount entered in Column A to other income previously reported for this calendar year, if any, and enter the amount in Column B, Calendar Year-to-Date.

Total Receipts: Add the amounts entered on lines 1-A, 1-B and 1-C, in Column A and enter the total in Total Receipts. Add the amount of Total Receipts previously reported, if any, and enter the amount in Column B, Calendar Year-to-Date. Disbursements 2A. Gross Expenditures: Enter the amount from Total Expenditures (Schedule 2-A) in Column A of the Summary page. Add the amount in Column A to expenditures previously reported for this calendar year, if any, and enter the amount in Column B, Calendar Year-to-Date.

2B.Contributions to Committees (Transfers-Out): Enter the amount from Total Contributions (Transfers-Out) Made to Committees (Schedule 2-B) in Column A of the Summary page. Add the amount in Column A to contributions previously reported for this calendar year, if any, and enter the amount in Column B, Calendar Year-to-Date. Total Disbursements: Add the amounts entered on lines 2-A and 2-B in Column A and enter the total in Total Disbursements. Add this amount to Total Disbursements previously reported, if any, and enter the amount in Column B, Calendar Year-to-Date. Cash Summary Cash Balance Beginning of Report: If this report is the first report filed by the committee, the cash balance will be zero. If this is not the first report filed by the committee, enter the cash balance from the end of the last report period. The beginning cash balance of a report must always be the same as the ending cash balance of the prior report.

Total Receipts: Enter the amount from Total Receipts in Column A of the Summary page. Subtotal: Add Cash Balance Beginning of Report to Total Receipts and enter the amount. Total Disbursements: Enter the amount from Total Disbursements in Column A of the Summary page. Cash Balance End of Report: Subtract Total Disbursements from Subtotal and enter the amount. The cash balance at the end of the report period should equal the reconciled balance in the checking account plus any savings or investment accounts. Incurred Obligations: Enter the amount from Total Incurred Obligations (Schedule 3-A) in Column A of the Summary page. Incurred obligations must be carried forward on each report until paid in full.

Loans: Enter the amount from the Total Outstanding Loans (Schedule 3-B) in Column A of the Summary page. Loans must be carried forward on each report until paid in full. Sign and Date the Report The treasurer or candidate must sign and date each report filed. Each report must be complete, correct, and in compliance with the reporting format. Please include a daytime phone number and a contact person if someone other than the treasurer prepares the report.

SCHEDULE 1-A RECEIPTS Contributions (Including Loans) From Individuals Page _ of ____ Complete Committee Name Instructions for completing schedules are on the back of each schedule. Date / / Full Name, Mailing Address and Zip Code Occupation, Name and Address of Principal Place Of Employment (if year-to-date total exceeds $100) Amount Calendar Year-to-Date Total Check if: In-Kind Loan Conduit Conduit Name _ _ Date / / Full Name, Mailing Address and Zip Code Occupation, Name and Address of Principal Place Of Employment (if year-to-date total exceeds $100) Amount Calendar Year-to-Date Total Check if: In-Kind Loan Conduit Conduit Name _ _ Date / / Full Name, Mailing Address and Zip Code Occupation, Name and Address of Principal Place Of Employment (if year-to-date total exceeds $100) Amount Calendar Year-to-Date Total Check if: In-Kind Loan Conduit Conduit Name _ _ Date / / Full Name, Mailing Address and Zip Code Occupation, Name and Address of Principal Place Of Employment (if year-to-date total exceeds $100) Amount Calendar Year-to-Date Total Check if: In-Kind Loan Conduit Conduit Name _ _ Date / / Full Name, Mailing Address and Zip Code Occupation, Name and Address of Principal Place Of Employment (if year-to-date total exceeds $100) Amount Calendar Year-to-Date Total Check if: In-Kind Loan Conduit Conduit Name _ _ Date / / Full Name, Mailing Address and Zip Code Occupation, Name and Address of Principal Place Of Employment (if year-to-date total exceeds $100) Amount Calendar Year-to-Date Total Check if: In-Kind Loan Conduit Conduit Name _ _ Date / / Full Name, Mailing Address and Zip Code Occupation, Name and Address of Principal Place Of Employment (if year-to-date total exceeds $100) Amount Calendar Year-to-Date Total Check if: In-Kind Loan Conduit Conduit Name _ _ Date / / Full Name, Mailing Address and Zip Code Occupation, Name and Address of Principal Place Of Employment (if year-to-date total exceeds $100) Amount Calendar Year-to-Date Total Check if: In-Kind Loan Conduit Conduit Name _ _ SUBTOTAL ITEMIZED CONTRIBUTIONS THIS PAGE $ TOTAL ITEMIZED CONTRIBUTIONS $ TOTAL UNITEMIZED CONTRIBUTIONS $20 OR LESS $ TOTAL CONTRIBUTIONS RECEIVED FROM INDIVIDUALS $

Instructions for Completing Schedule 1-A RECEIPTS - Contributions (Including Loans) From Individuals General Instructions: ɱ Print or type the complete name of your committee in the box provided. ɱ Duplicate as many pages as you will need in order to report contributions, including loans from individuals, on this form. ɱ Enter the number of Schedule 1-A pages in the upper right corner of the form. Date: Enter the date (month, day, year) each contribution was RECEIVED. Do not enter the date that appears on the contributor’s check or the date deposited, unless it is the same as the date received (is in committee’s possession and control). Full Name, Mailing Address, and Zip Code: 1. For contributions over $20: Enter the full name and address of the contributor. 2. For single or cumulative contributions totaling over $100 in a calendar year: Enter the full name and address of the contributor. Enter the occupation and the name and address of principal place of employment. Calendar Year-to-Date Total: Add contributions previously received this calendar year, from this contributor to the contributions received in this report period. The Calendar Year-to-Date Total for an individual must always be entered. The Current Amount and Year-to-Date Total will be identical on the first report period of the calendar year. Once the individual’s Calendar Year-to-Date Total exceeds $100, you must enter the contributor’s occupation, and the name and address of the principal place of employment.

Subtotal Itemized Contributions this page: Enter the total of all the contributions listed on this page. If additional pages are used, enter the subtotal for each separate page. Total Itemized Contributions: Add the subtotals from all pages of Schedule 1-A. If more than one page, enter the total on only the last page of Schedule 1-A. Total Unitemized Contributions $20 or less: Enter the total of unitemized contributions of $20 or less only on the last page of Schedule 1-A. Total Contributions Received from Individuals: Add the Total Itemized Contributions to the Total Unitemized Contributions $20 or Less and enter the amount only on the last page of Schedule 1-A. Special Instructions: i Contributions and loans from individuals on Schedule 1-A include any cash, personal or individual loans, purchase of tickets to fundraising events, memberships, gifts, advances, in-kind contributions, and all other personal contributions from an individual including the candidate. An in-kind contribution is any goods, property, or services provided to the committee free or for less than the fair market value. (Volunteer services are not a contribution. i In-kind contributions from individuals must also be reported as in-kind expenditures on Schedule 2-A to avoid distortion of the cash balance.

i When the contribution is in-kind, a loan, or is received through a conduit, check the appropriate box in the section where the contribution is listed. If you receive a personal check or cash, no box needs to be checked. i Contributions from individuals transferred through conduits are reported on Schedule 1-A under the individual contributor’s name with the name of the conduit listed. The transmittal letter accompanying the conduit check, identifies the conduit and lists the individuals who are the original sources of the contributions. These contributions are subject to itemization on the same basis as other individual contributions; if over $100, the occupation, name, and address of employer must be provided.

i Any individual loans, either from the candidate or from another individual, must be reported on Schedule 1-A and on Schedule 3-B, Additional Disclosure, Loans, until paid in full. Loans from individuals are subject to individual contribution limits (see Campaign Finance Manual). i Each contributor’s name, address, and amount must be listed separately. Contributions from joint accounts shall be reported as coming from the individual signing the check, unless the signor indicates otherwise. If the amount is divided, each individual must be itemized separately. Do not report a contribution as coming from more than one individual. i Receipts from raffles, auctions, garage sales, and other similar fundraising events are individual contributions and must be recorded. When receipts consist of single contributions of $20 or less, please report the amount in Unitemized Receipts of $20 or Less. Any single contributions that exceed $20 must be itemized.

i Do not report contributions from political action committees, political party committees, or other candidate committees on Schedule 1-A. These contributions must be reported on Schedule 1-B.

SCHEDULE 1-B RECEIPTS Page _ of ____ Contributions from Committees (Transfers-In) Complete Committee Name Instructions for completing schedules are on the back of each schedule. Date / / Full Name of Committee, Mailing Address and Zip Code Check if: In-Kind Loan Amount Calendar Year-To-Date Total Date / / Full Name of Committee, Mailing Address and Zip Code Check if: In-Kind Loan Amount Calendar Year-To-Date Total Date / / Full Name of Committee, Mailing Address and Zip Code Check if: In-Kind Loan Amount Calendar Year-To-Date Total Date / / Full Name of Committee, Mailing Address and Zip Code Check if: In-Kind Loan Amount Calendar Year-To-Date Total Date / / Full Name of Committee, Mailing Address and Zip Code Check if: In-Kind Loan Amount Calendar Year-To-Date Total Date / / Full Name of Committee, Mailing Address and Zip Code Check if: In-Kind Loan Amount Calendar Year-To-Date Total Date / / Full Name of Committee, Mailing Address and Zip Code Check if: In-Kind Loan Amount Calendar Year-To-Date Total Date / / Full Name of Committee, Mailing Address and Zip Code Check if: In-Kind Loan Amount Calendar Year-To-Date Total Date / / Full Name of Committee, Mailing Address and Zip Code Check if: In-Kind Loan Amount Calendar Year-To-Date Total Date / / Full Name of Committee, Mailing Address and Zip Code Check if: In-Kind Loan Amount Calendar Year-To-Date Total SUBTOTAL CONTRIBUTIONS (Transfers-In) THIS PAGE $ TOTAL CONTRIBUTIONS (Transfers-In) RECEIVED FROM COMMITTEES $

Instructions for Completing Schedule 1-B RECEIPTS Contributions From Committees (Transfers-In) General Instructions: ɱ Print or type the complete name of your committee in the box provided. ɱ Duplicate as many pages as you will need in order to report contributions from committees (transfers-in) on this form. ɱ Enter the number of Schedule 1-B pages in the upper right corner of the form. ɱ Each contribution received from a committee must be itemized regardless of the amount. Date: Enter the date (month, day, year) each contribution was received. DO NOT enter the date which appears on the contributor’s check or the date deposited, unless it is the same as the date received.

Complete Name and Address of Committee: Enter the full name and address of each contributor. If the committee is not registered with the Government Accountability Board or with the local clerk, you are not allowed to accept it. Amount: Enter the amount of the contribution this period. Calendar Year-to-Date Total: Add contributions previously received this calendar year, from this committee to the contributions received in this report period. The Calendar Year-to-Date Total for a committee must always be entered. The Current Amount and Year-to-Date Total will be identical on the first report period of the calendar year.

Subtotal Contributions (Transfers-In) This Page: Enter the total of all the contributions (transfers-in) listed on this page. If additional pages are needed, enter the subtotal for each separate page. Total Contributions (Transfers-In) Received from Committees: Add the subtotals from all pages of Schedule 1-B. If more than one page, enter the total on only the last page of Schedule 1-B. Special Instructions: i Contributions transferred through conduits are reported as individual contributions on Schedule 1-A. i In reporting contributions from committees, provide the complete name and address of each committee making a contribution.

i Contributions From Committees (Transfers-In) consist of any funds received from a political party committee, political action committee, political group (referenda), candidate committee or a legislative campaign committee. i In-kind contributions from a committee must also be reported as an in-kind offset in Schedule 2-A to avoid distortion of the cash balance. An in-kind contribution is any goods, service, or property provided to the committee free or for less than the fair market value. (Volunteer services are not a contribution.) i When the contribution is in-kind, check the in-kind box in the section where the contribution is listed. i Contributions received from a sole proprietorship or partnership must be reported as individual contributions in Schedule 1-A. You must verify that the original source of the contribution is from personal funds. Contributions from partnerships must reflect the partners’ share in the partnership unless otherwise specified. i Contributions may not be accepted from corporations (including LLC), cooperatives, associations, or unregistered committees.

SCHEDULE 1-C RECEIPTS Other Income and Commercial Loans Page _ of ____ Complete Committee Name Instructions for completing schedules are on the back of each schedule. Date / / Full Name, Mailing Address and Zip Code of Source of Income Type of Income Amount Date / / Full Name, Mailing Address and Zip Code of Source of Income Type of Income Amount Date / / Full Name, Mailing Address and Zip Code of Source of Income Type of Income Amount Date / / Full Name, Mailing Address and Zip Code of Source of Income Type of Income Amount Date / / Full Name, Mailing Address and Zip Code of Source of Income Type of Income Amount Date / / Full Name, Mailing Address and Zip Code of Source of Income Type of Income Amount Date / / Full Name, Mailing Address and Zip Code of Source of Income Type of Income Amount Date / / Full Name, Mailing Address and Zip Code of Source of Income Type of Income Amount Date / / Full Name, Mailing Address and Zip Code of Source of Income Type of Income Amount Date / / Full Name, Mailing Address and Zip Code of Source of Income Type of Income Amount SUBTOTAL OTHER INCOME THIS PAGE $ TOTAL ITEMIZED OTHER INCOME $ TOTAL UNITEMIZED OTHER INCOME $20 OR LESS $ TOTAL OTHER INCOME $

Instructions for Completing Schedule 1-C RECEIPTS Other Income and Commercial Loans General Instructions: ɱ Print or type the complete name of your committee in the box provided. ɱ Duplicate as many pages as you will need in order to report other income and commercial loans on this form. ɱ Enter the number of Schedule 1-C pages in the upper right corner of the form. Date: Enter the date (month, day, year) other income and commercial loans were RECEIVED. Full Name, Mailing Address and Zip Code of Source of Income: Identify the source of income by providing the name and address of the commercial lending institution. Provide the name and address of any person or business from which other income was received.

Describe Type of Income: Describe the type of income, e.g., loan from commercial lender for campaign expenses, refund from utility, refund of an over-payment to a vendor, interest on savings, or returned or lost contribution checks previously listed on Schedule 2-B, etc. Use more than one box or attach an additional sheet if needed. Amount: Enter the amount of other income and commercial loans of more than $20 for this period only. Subtotal Other Income This Page: Enter the total of all the other income itemized on this page. If additional pages are used, enter the subtotal for each separate page.

Total Itemized Other Income: Add the subtotals from all pages of Schedule 1-C. If more than one page, enter the total on only the last page of Schedule 1-C. Total Unitemized Other Income $20 or less: Enter the total of unitemized other income of $20 or less on the last page of Schedule 1-C. Total Other Income: Add the Total Itemized Other Income to the Total Unitemized Other Income of $20 or Less and enter the amount on only the last page of Schedule 1-C. Special Instructions: i Personal loans from individuals (including the candidate) must be reported on Schedule 1-A. i Other income and commercial loans include loans received from any financial institution. Loans must also be listed on Schedule 3-B, Additional Disclosure-Loans, until paid in full.

i When a contribution given by your committee to another committee is returned to you, report the receipt of the returned contribution in this schedule. Please indicate (under the Type of Income box) the original date your contribution was given. i When a loan from a commercial lending institution is guaranteed by individuals, the full name and mailing address of each guarantor and the balance of the amount guaranteed by each guarantor at the end of the reporting period must be reported on Schedule 3-B. The amount of the guarantee is considered a contribution from the guarantor and subject to individual contribution limits until the amount is repaid to the lending institution. i Other income includes refunds and interest received. Receipts from fundraising events (auctions, dinners, etc.) and from the sale of commercial items for the purpose of raising funds for political purposes are contributions and must be reported on Schedule 1-A or 1-B.

SCHEDULE 2-A DISBURSEMENTS Gross Expenditures Page ___ of ___ Complete Committee Name Instructions for completing schedules are on the back of each schedule. Date / / Full Name, Mailing Address and Zip Code Of Person or Business to Whom Payment is Made Check if: In-Kind Offset Specific Purpose of Expenditure Amount Date / / Full Name, Mailing Address and Zip Code Of Person or Business to Whom Payment is Made Check if: In-Kind Offset Specific Purpose of Expenditure Amount Date / / Full Name, Mailing Address and Zip Code Of Person or Business to Whom Payment is Made Check if: In-Kind Offset Specific Purpose of Expenditure Amount Date / / Full Name, Mailing Address and Zip Code Of Person or Business to Whom Payment is Made Check if: In-Kind Offset Specific Purpose of Expenditure Amount Date / / Full Name, Mailing Address and Zip Code Of Person or Business to Whom Payment is Made Check if: In-Kind Offset Specific Purpose of Expenditure Amount Date / / Full Name, Mailing Address and Zip Code Of Person or Business to Whom Payment is Made Check if: In-Kind Offset Specific Purpose of Expenditure Amount Date / / Full Name, Mailing Address and Zip Code Of Person or Business to Whom Payment is Made Check if: In-Kind Offset Specific Purpose of Expenditure Amount Date / / Full Name, Mailing Address and Zip Code Of Person or Business to Whom Payment is Made Check if: In-Kind Offset Specific Purpose of Expenditure Amount Date / / Full Name, Mailing Address and Zip Code Of Person or Business to Whom Payment is Made Check if: In-Kind Offset Specific Purpose of Expenditure Amount SUBTOTAL ITEMIZED EXPENDITURES THIS PAGE $ TOTAL ITEMIZED EXPENDITURES $ TOTAL UNITEMIZED EXPENDITURES $20 OR LESS $ TOTAL EXPENDITURES $

Instructions for Completing Schedule 2-A DISBURSEMENTS Gross Expenditures General Instructions: ɱ Print or type the complete name of your committee in the box provided. ɱ Duplicate as many pages as you will need in order to report gross expenditures on this form. ɱ Enter the number of Schedule 2-A pages in the upper right corner of the form. Date: Enter the date (month, day, year) the disbursement was made. Full Name, Mailing Address, and Zip Code of Person or Business to Whom Payment Is Made: Enter the name and complete address of the person or business to whom payments were made.

Specific Purpose of Expenditure: Enter the specific purpose of the expenditure. Expenditures must be made for political purposes only. An expenditure is for a political purpose when it influences the election or nomination for election of any individual to federal, state or local office. A complete description of the type of expenditure or reimbursement must be given (i.e., food for fundraiser or campaign T-shirts for resale). You may use more than one box or attach an additional sheet if needed. Subtotal Itemized Expenditures This Page: Enter the total of all the expenditures listed on this page. If additional pages are used, enter the subtotal for each separate page.

Total Itemized Expenditures: Add the subtotals from all pages of Schedule 2-A. If more than one page, enter the total itemized on only the last page of Schedule 2-A. Total Unitemized Expenditures $20 or less: Enter the total of unitemized expenditures of $20 or less on only the last page of Schedule 2-A. Note: If you itemize expenditures of $20 or less, DO NOT include those amounts again in the total of unitemized expenditures. Total Expenditures: Add the Total Itemized Expenditures to the Total Unitemized Expenditures ($20 or less), and enter the amount on the last page of Schedule 2-A.

Special Instructions: i Only expenditures of more than $20 must be itemized. Expenditures of $20 or less should be totaled and reported as unitemized expenditures. i Expenditures for general services, such as consulting, data processing, or reimbursement, should be broken down into the specific services rendered, e.g., salary, travel, data entry, polling. i In-kind contributions reported in Schedule 1-A or 1-B, must also be reported as in-kind offsets in Schedule 2-A. i Expenditures incurred for in-kind contributions to other registrants must be reported in Schedule 2-B, NOT 2-A. See instructions on Schedule 2-B.

i All expenditures must be made from the campaign depository and must be used for political purposes only. i It is permissible for a candidate or an agent of a committee to pay for items from personal funds as long as receipts are submitted to the treasurer for reimbursement from the depository. Reporting of a reimbursement must include information that describes the nature of the original expenditure, and the original vendor of the good(s) or service(s). i It is permissible to maintain a petty cash account to pay for minor items provided that funds for the petty cash account are drawn from the campaign depository and that a record of the transactions is kept. Expenditures over $20 must be paid by negotiable instrument, and be itemized on the report. Expenditures under $20 may be included in unitemized expenditures. If itemized, the purpose of each expenditure must be provided. Only the specific expenditures are reported. Contributions received, deposited, and later returned to the original contributor must be reported as an expense in Schedule 2-A. i Independent expenditures made by committees filing the Oath for Committees and Individuals Making Independent Disbursements (GAB-6) must be reported in Schedule 2-A and itemized on the Report of Independent Disbursements (GAB-7).

SCHEDULE 2-B DISBURSEMENTS Contributions To Committees (Transfers-Out) Page _ of _ _ Complete Committee Name Instructions for completing schedules are on the back of each schedule. Date / / Full Name, Mailing Address and Zip Code Check if: In-Kind Loan Amount Calendar Year-To-Date Total Date / / Full Name, Mailing Address and Zip Code Check if: In-Kind Loan Amount Calendar Year-To-Date Total Date / / Full Name, Mailing Address and Zip Code Check if: In-Kind Loan Amount Calendar Year-To-Date Total Date / / Full Name, Mailing Address and Zip Code Check if: In-Kind Loan Amount Calendar Year-To-Date Total Date / / Full Name, Mailing Address and Zip Code Check if: In-Kind Loan Amount Calendar Year-To-Date Total Date / / Full Name, Mailing Address and Zip Code Check if: In-Kind Loan Amount Calendar Year-To-Date Total Date / / Full Name, Mailing Address and Zip Code Check if: In-Kind Loan Amount Calendar Year-To-Date Total Date / / Full Name, Mailing Address and Zip Code Check if: In-Kind Loan Amount Calendar Year-To-Date Total Date / / Full Name, Mailing Address and Zip Code Check if: In-Kind Loan Amount Calendar Year-To-Date Total Date / / Full Name, Mailing Address and Zip Code Check if: In-Kind Loan Amount Calendar Year-To-Date Total SUBTOTAL CONTRIBUTIONS (Transfers-Out) THIS PAGE $ TOTAL CONTRIBUTIONS (Transfers-Out) MADE TO COMMITTEES $

Instructions for Completing Schedule 2-B DISBURSEMENTS Contributions to Committees General Instructions: ɱ Print or type the complete name of your committee in the box provided. ɱ Duplicate as many pages as you will need in order to use this form to report Contributions to Committees (Transfers-Out). Enter the number of Schedule 2-B pages in the upper right corner of the form. ɱ Each contribution made to another committee must be itemized regardless of the amount. Date: Enter the date (month, day, year) that each contribution was made to another committee. Complete Name and Address of Committee: Enter the full name and address of each committee. Amount: Enter the amount of the contribution given in this period. Calendar Year-to-Date Total: Add contributions previously given this calendar year to this committee, to the contributions given in this report period. The Calendar Year-to-Date Total for a committee must always be entered. The Current Amount and Year-to-Date Total will be identical on the first report period of the calendar year.

Subtotal Contributions (Transfers-Out) This Page: Enter the total of all the contributions (Transfers-Out) listed on this page. If additional pages are used, enter the subtotal for each separate page. Total Contributions (Transfers-Out) Made to Committees: Add the subtotals from all pages of Schedule 2-B. If more than one page, enter the total on only the last page of Schedule 2-B. Special Instructions: i If a contribution is made to a candidate for local office, please print the word “Local” in the space for the ID#. This would include candidates for municipal, school district, and county office. Note: District Attorney and Circuit Court Judge are considered state offices.

i Contributions to Committees (Transfers-Out) consist of any funds contributed to a political party committee, political action committee, political group (referenda), candidate committee, or legislative campaign committee. i When the contribution is in-kind, check the in-kind box in the section where the contribution is listed. i When the contribution is a loan, check the loan box in the section where the contribution is listed. i For each in-kind contribution, the name and address of the candidate or committee receiving the contribution must be listed, along with the name and address of the person or business to whom payment was made and the amount and date of the in-kind contribution.

1. If the committee purchases goods or services and gives them to another committee in the same reporting period as an in-kind contribution, the amount must be reported only once as an expense on Schedule 2-B. 2. If the committee already possesses goods or services and gives them to another committee as an in-kind contribution, the amount must be offset by a matching receipt (or negative expense) to avoid errors in the bank balance.

ADDITIONAL DISCLOSURE Incurred Obligations Excluding Loans SCHEDULE 3-A Page _ of ____ Complete Committee Name Instructions for completing schedules are on the back of each schedule. Outstanding Balance Beginning This Period New Obligations or Additions This Period Cumulative Payments This Period Outstanding Balance At Close of This Period Date / / Full Name, Mailing Address and Zip Code of Creditor Nature of Debt (Purpose) Date / / Full Name, Mailing Address and Zip Code of Creditor Nature of Debt (Purpose) Date / / Full Name, Mailing Address and Zip Code of Creditor Nature of Debt (Purpose) Date / / Full Name, Mailing Address and Zip Code of Creditor Nature of Debt (Purpose) Date / / Full Name, Mailing Address and Zip Code of Creditor Nature of Debt (Purpose) Date / / Full Name, Mailing Address and Zip Code of Creditor Nature of Debt (Purpose) Date / / Full Name, Mailing Address and Zip Code of Creditor Nature of Debt (Purpose) Date / / Full Name, Mailing Address and Zip Code of Creditor Nature of Debt (Purpose) SUBTOTAL ITEMIZED OBLIGATIONS THIS PAGE $ TOTAL ITEMIZED OBLIGATIONS $ TOTAL UNITEMIZED OBLIGATIONS $20 OR LESS $ TOTAL INCURRED OBLIGATIONS $

Instructions for Completing Schedule 3-A ADDITIONAL DISCLOSURE Incurred Obligations Excluding Loans General Instructions: ɱ Print or type the complete name of your committee in the box provided. ɱ Duplicate as many pages as you will need in order to report incurred obligations on this form. ɱ Enter the number of Schedule 3-A pages in the upper right corner of the form. Date: Enter the date (month, day, year) the obligation was incurred. Full Name, Mailing Address, and Zip Code of Creditor: Enter the complete name and address of the creditor. Nature of Debt (Purpose): Describe the specific purpose for which the obligation was incurred (See Schedule 2-A for instructions). Balance Columns: In the first column, enter the amount, if any, at the beginning of this report period. If this is a new obligation, there is no beginning balance. If this is an existing obligation, the beginning balance should equal the previous report period’s closing balance. In the second column, enter the amount of any new obligations or additions to existing obligations. In the third column, enter any payments made this report period (payments this period must also be reported in Schedule 2-A). In the fourth column, enter the outstanding balance at the close of this report period. Note: If there is a remaining balance, it must be carried forward to the next report’s beginning balance.

Subtotal Itemized Obligations: Enter the total of all the incurred obligations listed on this page. If additional pages are used, enter the subtotal for each separate page. Total Itemized Obligations: Add the subtotals from all pages of Schedule 3-A. If more than one page, enter the total on only the last page of Schedule 3-A. Total Unitemized Obligations $20 or less: Enter the total unitemized obligations of $20 or less on only the last page of Schedule 3-A. Total Incurred Obligations: Add the Total Itemized Obligations to the Total Unitemized Obligations $20 or Less and enter the amount on only the last page of Schedule 3-A.

Special Instructions: i Incurred obligations are to be reported when an enforceable agreement has been reached. If the exact amount of the obligation has not yet been defined then the amount of the obligation must be estimated. Although the committee may not have received a bill, the amount recorded should be a good faith estimate of the amount owed. i The balance of all incurred obligations should be reported from the time incurred until paid in full. i Each obligation must be carried forward on subsequent reports until the obligation has been reduced to zero. i When a payment is made on an obligation, the transaction should be reported as a payment on Schedule 3-A and as an expenditure on Schedule 2-A.

i If the committee has a dispute over the amount owed to a vendor, this must be noted in the “purpose”.

SCHEDULE 3-B ADDITIONAL DISCLOSURE Loans Individual, Committee or Commercial Page _ of ____ Complete Committee Name Instructions for completing schedules are on the back of each schedule. Full Name, Mailing Address and Zip Code of Loan Source Outstanding Balance Beginning of This Period New Loans This Period Cumulative Payments This Period Outstanding Balance End of This Period Date / / List All Endorsers or Guarantors (if any) Full Name, Mailing Address and Zip Code of Guarantor Occupation Name and Address of Employer Amount Guaranteed Outstanding $ Full Name, Mailing Address and Zip Code of Guarantor Occupation Name and Address of Employer Amount Guaranteed Outstanding $ Full Name, Mailing Address and Zip Code of Loan Source Outstanding Balance Beginning of This Period New Loans This Period Cumulative Payments This Period Outstanding Balance End of This Period Date / / List All Endorsers or Guarantors (if any) Full Name, Mailing Address and Zip Code of Guarantor Occupation Name and Address of Employer Amount Guaranteed Outstanding $ Full Name, Mailing Address and Zip Code of Guarantor Occupation Name and Address of Employer Amount Guaranteed Outstanding $ Full Name, Mailing Address and Zip Code of Loan Source Outstanding Balance Beginning of This Period New Loans This Period Cumulative Payments This Period Outstanding Balance End of This Period Date / / List All Endorsers or Guarantors (if any) Full Name, Mailing Address and Zip Code of Guarantor Occupation Name and Address of Employer Amount Guaranteed Outstanding $ Full Name, Mailing Address and Zip Code of Guarantor Occupation Name and Address of Employer Amount Guaranteed Outstanding $ SUBTOTAL OUTSTANDING LOANS THIS PAGE $ TOTAL OUTSTANDING LOANS $

Instructions for Completing Schedule 3-B ADDITIONAL DISCLOSURE Loans – Individual, Committee or Commercial General Instructions: ɱ Print or type the complete name of your committee in the box provided. ɱ Duplicate as many pages as you will need in order to report loans on this form. ɱ Enter the number of Schedule 3-B pages in the upper right corner of the form. Date: Enter the date (month, day, year) the loan was made. Full Name, Mailing Address, and Zip Code of Loan Source: Enter the complete name and address of the loan source. Balance Columns: In the first column, enter the actual amount at the beginning of this reporting period. If this is a new loan, the outstanding beginning balance is zero and the amount of the loan is recorded under the section “New Loans This Period”. If this is an existing loan, the outstanding beginning balance should equal the previous report period’s closing (outstanding) balance. In the third column, enter any payments made during this report period (payments made this period must also be reported in Schedule 2-A). In the fourth column, enter the outstanding balance at the end of this report period. Note: If there is a remaining balance, it must be carried forward to the next report’s beginning balance. List All Endorsers or Guarantors (If Any): In the space provided on the form, provide the full name, mailing address and zip code of any guarantors of loans. Enter the amount guaranteed which is outstanding at the end of the reporting period for each guarantor. See the notes below on how to apportion loan guarantees. If the amount guaranteed exceeds $100, enter the guarantor’s occupation, name and address of principal place of employment.

Special Instructions: i A loan guarantee is considered a contribution from the guarantor until the loan is repaid. i If more than one person guarantees a loan, the amount of the loan is assigned to the guarantors in equal shares, in the proportion that the guarantors bear to the total amount guaranteed unless a different share is specified in the loan instrument. i When a payment which reduces the unpaid balance of the loan is made to the lending institution, the amount assigned to each guarantor is reduced in equal shares, unless a different share is specified in the loan instrument. i The outstanding amount of a loan or loan guarantee plus the total contributions to the campaign by the guarantor may not exceed the individual contribution limit.

i Any reductions in loans which are not offset by expenditures in Schedule 2-A must be explained (e.g., candidate forgives self loans).

CAMPAIGN REGISTRATION STATEMENT STATE OF WISCONSIN FOR OFFICE USE ONLY GAB-1 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 † 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) City, State and Zip Code Election Date Candidate Telephone Number (employment) Campaign Committee Name (if any) Check One: † Personal Campaign Committee † Support Committee Candidate Email Address Campaign Committee Address (if different than above) - Number, Street, City, State and Zip Code Committee Email Address Telephone Number (if different than above) 2. POLITICAL COMMITTEE INFORMATION (For use ONLY by Political Action Committees, Political Party Committees, Political Groups, etc.) Name of Committee Address - Number, Street, City, State and Zip Code Telephone Number Committee Email Address Sponsoring Organization - Name and Complete Address Acronym (if any) Type of Committee: A. † Special Interest Committee (PAC) † Resident Committee † Nonresident Committee – (Must also file GAB-40 with WI Secretary of State’s Office) † Incorporated Labor Organization - Attach Information Required by s.11.05(3)(n), Stats. B. † Political Party Committee † National † State † County † Other _ _ C. † Legislative Campaign Committee – Attach Statement Required by s.11.05(3)(o), Stats. D. † Political Group (Referendum † Support † Oppose Name of Referendum E. † Recall Committee † Support Recall † Oppose Recall Name of Officer Subject to Recall - Attach Statement Required by s.9.10(2)(d) F. † Independent Disbursement Committee - Also, Complete Oath of Independent Expenditures, Form GAB-6 G. † Individual - Also, Complete Oath of Independent Expenditures, Form GAB-6 GAB-1 (Rev. 03/14) THIS FORM IS PRESCRIBED BY: WISCONSIN GOVERNMENT ACCOUNTABILITY BOARD P.O. Box 7984, Madison, WI 53707-7984 | Phone: 608-261-2028 | Fax: 608-264-9319 | Web: https://cfis.wi.gov | Email: GABCFIS@wi.gov Completed forms for local committees are to be filed with your local clerk’s office.

3. COMMITTEE TREASURER (Campaign finance correspondence is mailed to this address.) Treasurer’s Name Telephone Number (residence) Address (number and street) Telephone Number (employment) City, State and Zip Code Treasurer Email Address 4. PRINCIPAL OFFICERS OF COMMITTEE AND OTHER CUSTODIANS OF BOOKS AND ACCOUNTS Attach additional listing if necessary. Indicate which officers or committee members are authorized to fill a vacancy in nomination due to death of candidate by an asterisk(*). This provision only applies to independent and local nonpartisan candidates. s.8.35, Stats.

NAME MAILING ADDRESS Email Address Phone # POSITION 5. DEPOSITORY INFORMATION Name of Financial Institution Account Number (Attach list of any additional accounts and deposit boxes, location, type and number, i.e., savings, checking, money market, etc.) Address (number and street) City, State and Zip Code CERTIFICATION TREASURER I ( print full name) certify the information in this statement is true, correct and complete. Signature , Treasurer _ _ Date CANDIDATE (or Recall Petitioner) I _ ( print full name) certify the information in this statement is true, correct and complete, and that this is the only committee authorized to act on my behalf. Signature , Candidate/Petitioner _ _ Date + EXEMPTION FROM FILING CAMPAIGN FINANCE REPORTS §11.05(2r), Wis. Stats + You may be eligible for an exemption from filing campaign finance reports. Consult the Campaign Finance Manual to determine if the registrant 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 $1,000 in a calendar year or accept any contribution or cumulative contributions of more than $100 from a single source during the calendar year, except contributions by a candidate to his or her campaign of $1,000 or less in a calendar year. † This registrant is no longer eligible to claim exemption. _ _ Signature of Candidate or Treasurer Date THE INFORMATION ON THIS FORM IS REQUIRED BY §§9.10(2)(d), 11.05, 11.06(7), WIS. STATS. FAILURE TO PROVIDE THE INFORMATION MAY SUBJECT YOU TO THE PENALTIES OF §§8.30(2), 11.60, 11.61, 11.66, WIS. STATS.

CAMPAIGN REGISTRATION STATEMENT (GAB-1) INSTRUCTIONS Campaign Treasurer - Section 3 should be completed by all committees. All committees must name a treasurer. A Candidate may designate any elector to serve as their treasurer, or the candidate may server as his/her own treasurer. It is important that the treasurer’s name, complete address, telephone number and email 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.

Depository Information (MANDATORY) In some cases, banks may require a completed GAB-1 registration form to open a bank account. Your committee may register without a bank account, but the GAB-1 form must be amended within 10 days to report any change, including a new bank account number. Failure to provide depository information within 5 business days of the first donation and before making any disbursements may disqualify a candidate for ballot placement. (Wis. Stats. §11.10(1)) In general, all committees must have and provide a campaign depository account number. One of three things must be entered here: 1. Separate Campaign bank account o This account may be used only for campaign funds o The bank may require an Employer Identification Number (EIN) 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 $1,000 of receipts, under $1,000 expenses, no more than $100 from a single source) 3. Only Candidates are allowed to not have a bank account, but only if: o The candidate will receive no contributions and make no disbursements. No communications may be authorized or distributed. This includes in-kind contributions and expenses. o The candidate must claim exemption by checking the appropriate box on this form. o The candidate should add a hand-written statement to the form that he or she will spend no money. Candidates running for more than one elected office are only allowed one campaign depository account. All contributions and all disbursements for all offices must be run through the one account.

Certification The candidate and committee treasurer must sign the original registration statement of a personal campaign committee or a support committee certifying that the information is true, correct, and complete, and that the committee is the only committee authorized to act on the candidate’s behalf. 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. Exemption From Filing 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 non-candidate committee may not accept more than $100 from any single source (individual or committee) in one calendar year.

o A candidate committee may not accept more than $100 from any other single source (individual or committee) in a calendar year. The candidate may contribute up to $1000 to their own committee. o A committee may not spend more than $1000 total in a calendar year. o A referenda committee that does not accept contributions, make disbursements, or incur obligations of more than $2,500 is not required to register or file campaign finance reports. Referenda committees over this threshold may not claim exemption – they must register and file all required reports.

If a committee on exempt status exceeds any of the limits listed above: o The committee must immediately file an amended GAB-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. Any reports past their deadline that were not filed should be filed as soon as possible. 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 31st . Include an updated GAB-1 requesting exempt status for the upcoming year.

Amending a Registration Statement When any of the information reported on the registration statement changes the statement must be amended by filing a new GAB-1. The candidate or treasurer must file the new GAB-1 within 10 days of the change, checking the “yes” box at the top of the form to indicate that it is an amendment.

SCHEDULE 4 TERMINATION REQUEST Complete Committee Name x A committee may terminate its registration and reporting requirements if the committee will no longer receive contributions, make disbursements or incur obligations, and the cash balance and obligations have been reduced to zero. x Candidates may not terminate prior to the election in which they are participating. x Please read carefully and, if necessary, indicate how residual committee funds have been disposed of or if outstanding loans or obligations have been forgiven. Sign and date the termination request at the bottom of this page. x Make sure the termination box on the cover page of this report is checked. x Please note: An audit must be completed and all obligations, including settlement offers, fulfilled before termination can be granted. All records must be maintained until 3 years after the date of an election in which the registrant participates, even if termination is granted. (Per Wis. Stats. 11.12(3)) DISPOSAL OF RESIDUAL FUNDS THIS INFORMATION SHOULD ALSO BE INCLUDED ON SCHEDULE 2-A AND/OR 2-B. Date Recipient Amount LOAN OR DEBT FORGIVENESS I hereby forgive all personal loans or have assumed responsibility for any and all debts of my campaign committee. Date Endorser, Guarantor, or Creditor Amount TERMINATION REQUEST. I hereby request that the committee registration be terminated. I declare that the committee has not incurred any obligations and does not anticipate incurring any. The committee does not anticipate receiving any further contributions or making any disbursements. I further state that the cash balance has been reduced to zero and that all remaining funds have been disposed of in the manner prescribed by law.

_ _ Signature of Candidate or Treasurer Date

SPECIAL REPORT OF LATE CONTRIBUTION CANDIDATE/COMMITTEE/INDIVIDUAL INFORMATION Candidate/Committee/Individual Name GAB I.D. # (if assigned) Address (Number, Street) Email Address City, State, Zip Code Telephone Number CONTRIBUTOR INFORMATION (See Instructions on Reverse Side of Form) Complete Name of Contributor Date of Contribution Address (Number and Street) of Contributor AMOUNT OR FAIR MARKET VALUE OF CONTRIBUTION. _ _ Total Contribution(s) Received From Contributor Since Last Report _ _ City, State, Zip Code Occupation Name and Address of Principal Place of Employment Complete Name of Contributor Date of Contribution Address (Number and Street) of Contributor AMOUNT OR FAIR MARKET VALUE OF CONTRIBUTION.

_ _ Total Contribution(s) Received From Contributor Since Last Report _ _ City, State, Zip Code Occupation Name and Address of Principal Place of Employment Complete Name of Contributor Date of Contribution Address (Number and Street) of Contributor AMOUNT OR FAIR MARKET VALUE OF CONTRIBUTION. _ _ Total Contribution(s) Received From Contributor Since Last Report _ _ City, State, Zip Code Occupation Name and Address of Principal Place of Employment I , certify that the information in this report is true, correct and complete. (PRINT NAME) _ _ Signature of Candidate or Treasurer Date THE INFORMATION ON THIS FORM IS REQUIRED BY ss. 11.12(5), 11.23(6), STATS. FAILURE TO PROVIDE THE INFORMATION MAY SUBJECT YOU TO THE PENALTIES OF ss. 11.60, 11.61, 11.66, STATS.

THIS FORM IS PRESCRIBED BY: The Wisconsin Government Accountability Board, P.O. Box 7984, Madison, WI 53707-7984 | Phone: 608-261-2028 | Fax: 608-264-9319 | Web: https://cfis.wi.gov | Email: GABCFIS@wi.gov GAB-3 (Rev. 04/14)

INSTRUCTIONS FOR FILING SPECIAL REPORT OF LATE CONTRIBUTION When This Report is Required: A special report of late contribution must be filed for contributions of $500 or more received after the closing date of the Pre-Primary or Pre-Election report and before the primary or election. This report must be filed for 1) any contribution of $500 or more, and 2) contributions from a single source totaling $500 or more received during this 15 day period. It must be filed within 24 hours of receiving the contributions.

Who Must File This Report: This report must be filed by all statewide, legislative and judicial candidates receiving late contributions. Political party committees, and political action committees must file this report when receiving late contributions. Groups supporting or opposing a referendum must file this report only if already over the $2,500 registration threshold, or if the late contribution causes the referendum committee to exceed the $2,500 registration threshold. Local candidate committees are not required to file this report.

Where to File a Special Report of Late Contribution: The special report of late contribution must be filed with the appropriate filing officer. If the contribution is received by a committee or candidate registered with the Government Accountability Board, the report must be filed with the Government Accountability Board. If the contribution is received by a local political committee or group, the report must be filed with the appropriate clerk of the county, city, town, village or school district. Miscellaneous Information: 1. The report must be faxed, emailed, or postmarked within 48 hours of receipt of the contribution. 2. More than one contribution can be reported on this form.

3. The information contained in this special report of late contribution must be included on the next regular report filed by the registrant. The contribution must be included in the appropriate schedule: 1-A for contributions from individuals or 1-B for contributions from committees.

Certificate of Nomination General Instructions: Please Review Fully Please use uppercase (CAPITAL) letters only. Fill in circles as appropriate. This form is used to document the transmission of candidate information. Candidate names should be listed on the form in the order they should appear on the ballot. After entering information into SVRS, Providers should file this form for reference. Jurisdiction Information 1 Clerk Last Name Clerk First Name 2 School Dist. Union Unified Common 3 Relier Information Municipality Town Village City County HINDI # 4 Provider Information County HINDI # Municipality Town Village City HINDI # Election Information 5 Date of Election (MM/DD/YYYY) Type of Election Office Vote for 1 Vote for not more than: (Please Specify) Candidate Information 6 Ballot Position I , Clerk for the of , certify that the names of the candidates in Section 6 are for the office at the election on the date listed in Section 5, as determined by law, and that such names must be placed on the official ballot in the order listed.

7 Comments Signature School Clerk Signature X Date (MM/DD/YYYY) Relier Signature X Date (MM/DD/YYYY) Provider Signature X Date (MM/DD/YYYY) EB-405 (REV 1/2006) / / / / / / Town Village City Sch. Dist. / /

Certificate of Nomination 1 Whether School District Clerk or Relier Clerk, please provide your current last and first names in the spaces provided. Enter your formal names, as indicated on official government documents; no nicknames. 2 Only required if form is being completed on behalf of a School District. Fill in appropriate circle for type of School District. Complete name of School District. 3 Only required if form is being completed on behalf of a municipality. Fill in appropriate circle for type of municipality. Complete name of municipality. Complete name of county where municipality is located. 4 x To be completed by School District Clerk. Complete name of county where school district is located. If school district is located in more than one county, complete a separate form for each county. x To be completed by Relier Clerk. Complete name of county or municipality that provides SVRS services to you.

5 x Complete date of election. x Complete election type, i.e. Spring Primary, Spring Election, September Primary, General Election, Special Primary, Special Election. x Complete office, i.e. Town Supervisor, Village Trustee, Mayor, School Board Supervisor. x Fill in the circle to indicate that the office is to be listed on the ballot as “Vote for One” or “Vote for not more than”. If “Vote for not more than” indicate the number of seats to be elected. 6 x Complete the certification with the appropriate information for name of clerk and jurisdiction. x List candidates’ names as they should appear on the ballot and in the order they should appear. Signature: x By signing in this space, the School District Clerk is certifying the candidate information for the office at the election listed.

x By signing in this space, the Relier Clerk is certifying the candidate information for the office at the election listed. x By signing in this space the County Clerk or Provider Clerk is acknowledging receipt of this information and has entered this information into SVRS. 7 For School District Clerk, provide a list of municipalities within the school district. If additional space is required, please use a blank sheet of paper to document the municipalities and attach it to this form. General Instructions: Please Review Fully This form should be completed by either a school district clerk or a municipal clerk. The completed form should be submitted to your county clerk or provider, unless directed otherwise.

This form is used to transmit information about candidate ballot placement to be entered into SVRS. Clerks should complete a separate form for each county. If there are candidates for more than one office, complete a separate form for each office. This form constitutes a certificate of nomination that may also be used for ballot creation. Each section on the front side of this document corresponds to the sections below (1-6). EB-405 Instructions (REV 1/2006)

Official Primary Ballot for Nonpartisan Office Notice to Voters: This ballot may be invalid unless initialed by 2 election inspectors. If cast as an absentee ballot, the ballot must bear the initials of the municipal clerk or deputy clerk. Instructions to Voters:- If you make a mistake or have a question, see an election inspector. (Absentee Voters: Contact your municipal clerk.) To vote for a name on the ballot, make an “X” or other mark in the square next to the name. To vote for a name that is not on the ballot, write the name in the space marked “write-in.” School District School Board Members Vote for not more than 3 † Candidate Name † Candidate Name † Candidate Name † Candidate Name † Candidate Name † Candidate Name † Candidate Name write-in: write-in: write-in: GAB-222 Spring Primary Paper Ballot for School District Office – Unnumbered seats (2014-12)

Sample reverse side of official paper ballot (Insert title from front of ballot) (Insert date of election) For _ _ Insert name of municipality: city, town or village, and ward #(s) Ballot issued by _ _ _ _ Initials of election inspectors Absentee ballot issued by _ _ Initials of municipal clerk or deputy clerk (If issued by SVDs, both SVDs must initial.) Certification of Voter Assistance I certify that I marked this ballot at the request and direction of a voter who is authorized under the law to receive assistance.

_ _ Signature of assistor GAB-229 Reverse side of paper ballot| Rev 2015-01 | Government Accountability Board, P.O. Box 7984, Madison, WI 53707-7984 | 608-261-2028 | web: gab.wi.gov | email: gab@wi.gov

Official Primary Ballot for Nonpartisan Office Notice to Voters: This ballot may be invalid unless initialed by 2 election inspectors. If cast as an absentee ballot, the ballot must bear the initials of the municipal clerk or deputy clerk. Instructions to Voters If you make a mistake or have a question, see an election inspector. (Absentee Voters: Contact your municipal clerk.) To vote for a name on the ballot, make an “X” or other mark in the square next to the name. To vote for a name that is not on the ballot, write the name in the space marked “write-in.” School District School Board Member 1 School Board Member 3 Vote for 1 Vote for 1 † Candidate Name † Candidate Name † Candidate Name † Candidate Name † Candidate Name † Candidate Name write-in: write-in: School Board Member 2 Vote for 1 † Candidate Name † Candidate Name † Candidate Name write-in: Continue voting at top of next column. GAB-223 Spring Primary Paper Ballot for School District Office – Numbered seats (2014-12)

Sample reverse side of official paper ballot (Insert title from front of ballot) (Insert date of election) For _ _ Insert name of municipality: city, town or village, and ward #(s) Ballot issued by _ _ _ _ Initials of election inspectors Absentee ballot issued by _ _ Initials of municipal clerk or deputy clerk (If issued by SVDs, both SVDs must initial.) Certification of Voter Assistance I certify that I marked this ballot at the request and direction of a voter who is authorized under the law to receive assistance.

_ _ Signature of assistor GAB-229 Reverse side of paper ballot| Rev 2015-01 | Government Accountability Board, P.O. Box 7984, Madison, WI 53707-7984 | 608-261-2028 | web: gab.wi.gov | email: gab@wi.gov

Official Primary Ballot for Nonpartisan Office Notice to Voters: This ballot may be invalid unless initialed by 2 election inspectors. If cast as an absentee ballot, the ballot must bear the initials of the municipal clerk or deputy clerk. Instructions to Voters If you make a mistake or have a question, see an election inspector. (Absentee Voters: Contact your municipal clerk.) To vote for a name on the ballot, make an “X” or other mark in the square next to the name. To vote for a name that is not on the ballot, write the name in the space marked “write-in.” School District School Board Member from _ School Board Member from _ _ Vote for 1 Vote for 1 † Candidate Name † Candidate Name † Candidate Name † Candidate Name † Candidate Name † Candidate Name write-in: write-in: School Board Member from _ _ Vote for 1 † Candidate Name † Candidate Name † Candidate Name write-in: Continue voting at top of next column. GAB-224 Spring Primary Paper Ballot for School District Office – Area represented seats (2014-12)

Sample reverse side of official paper ballot (Insert title from front of ballot) (Insert date of election) For _ _ Insert name of municipality: city, town or village, and ward #(s) Ballot issued by _ _ _ _ Initials of election inspectors Absentee ballot issued by _ _ Initials of municipal clerk or deputy clerk (If issued by SVDs, both SVDs must initial.) Certification of Voter Assistance I certify that I marked this ballot at the request and direction of a voter who is authorized under the law to receive assistance.

_ _ Signature of assistor GAB-229 Reverse side of paper ballot| Rev 2015-01 | Government Accountability Board, P.O. Box 7984, Madison, WI 53707-7984 | 608-261-2028 | web: gab.wi.gov | email: gab@wi.gov

Official Ballot for Nonpartisan Office Notice to Voters: This ballot may be invalid unless initialed by 2 election inspectors. If cast as an absentee ballot, the ballot must bear the initials of the municipal clerk or deputy clerk. Instructions to Voters If you make a mistake or have a question, see an election inspector. (Absentee Voters: Contact your municipal clerk.) To vote for a name on the ballot, make an “X” or other mark in the square next to the name. To vote for a name that is not on the ballot, write the name on the line marked “write-in.” School Board Member Vote for not more than 3 † Candidate Name † Candidate Name † Candidate Name † Candidate Name † Candidate Name † Candidate Name write-in _ _ write-in _ _ write-in _ _ GAB-225 | Rev. 2015-01 | Government Accountability Board, P.O. Box 7984, Madison, WI 53707-7984 | 608-261-2028 |web: gab.wi.gov | email: gab@wi.gov Spring Election Paper Ballot for School District Office - Unnumbered Seats

Sample reverse side of official paper ballot (Insert title from front of ballot) (Insert date of election) For _ _ Insert name of municipality: city, town or village, and ward #(s) Ballot issued by _ _ _ _ Initials of election inspectors Absentee ballot issued by _ _ Initials of municipal clerk or deputy clerk (If issued by SVDs, both SVDs must initial.) Certification of Voter Assistance I certify that I marked this ballot at the request and direction of a voter who is authorized under the law to receive assistance.

_ _ Signature of assistor GAB-229 Reverse side of paper ballot| Rev 2015-01 | Government Accountability Board, P.O. Box 7984, Madison, WI 53707-7984 | 608-261-2028 | web: gab.wi.gov | email: gab@wi.gov

Official Ballot for Nonpartisan Office Notice to Voters: This ballot may be invalid unless initialed by 2 election inspectors. If cast as an absentee ballot, the ballot must bear the initials of the municipal clerk or deputy clerk. Instructions to Voters If you make a mistake or have a question, see an election inspector. (Absentee Voters: Contact your municipal clerk.) To vote for a name on the ballot, make an “X” in or other mark in the square next to the name. To vote for a name that is not on the ballot, write the name on the line marked “write-in.” School Board Member No. 1 School Board Member No. 3 Vote for 1 Vote for 1 † Candidate Name † Candidate Name † Candidate Name † Candidate Name write-in _ write-in _ _ School Board Member No. 2 Vote for 1 † Candidate Name † Candidate Name write-in _ _ GAB-226 | Rev. 2015-01 | Government Accountability Board, P.O. Box 7984, Madison, WI 53707-7984 | 608-261-2028 | web: gab.wi.gov | email: gab@wi.gov Spring Election Paper Ballot for School District Office – Numbered seats

Sample reverse side of official paper ballot (Insert title from front of ballot) (Insert date of election) For _ _ Insert name of municipality: city, town or village, and ward #(s) Ballot issued by _ _ _ _ Initials of election inspectors Absentee ballot issued by _ _ Initials of municipal clerk or deputy clerk (If issued by SVDs, both SVDs must initial.) Certification of Voter Assistance I certify that I marked this ballot at the request and direction of a voter who is authorized under the law to receive assistance.

_ _ Signature of assistor GAB-229 Reverse side of paper ballot| Rev 2015-01 | Government Accountability Board, P.O. Box 7984, Madison, WI 53707-7984 | 608-261-2028 | web: gab.wi.gov | email: gab@wi.gov

Official Ballot for Nonpartisan Office Notice to Voters: This ballot may be invalid unless initialed by 2 election inspectors. If cast as an absentee ballot, the ballot must bear the initials of the municipal clerk or deputy clerk. Instructions to Voters If you make a mistake or have a question, see an election inspector. (Absentee Voters: Contact your municipal clerk.) To vote for a name on the ballot, make an “X” or other mark in the square next to the name. To vote for a name that is not on the ballot, write the name on the line marked “write-in.” School Board Member from _ School Board Member from _ _ Vote for 1 Vote for 1 † Candidate Name † Candidate Name † Candidate Name † Candidate Name write-in _ write-in _ _ School Board Member from _ _ Vote for 1 † Candidate Name † Candidate Name write-in _ _ GAB-227 | Rev. 2015-01 | Government Accountability Board, P.O. Box 7984, Madison, WI 53707-7984 | 608-261-2028 | web: gab.wi.gov | email: gab@wi.gov Spring Election Paper Ballot for School District Office – Area represented seats

Sample reverse side of official paper ballot (Insert title from front of ballot) (Insert date of election) For _ _ Insert name of municipality: city, town or village, and ward #(s) Ballot issued by _ _ _ _ Initials of election inspectors Absentee ballot issued by _ _ Initials of municipal clerk or deputy clerk (If issued by SVDs, both SVDs must initial.) Certification of Voter Assistance I certify that I marked this ballot at the request and direction of a voter who is authorized under the law to receive assistance.

_ _ Signature of assistor GAB-229 Reverse side of paper ballot| Rev 2015-01 | Government Accountability Board, P.O. Box 7984, Madison, WI 53707-7984 | 608-261-2028 | web: gab.wi.gov | email: gab@wi.gov

Tabular Statement of Votes Cast , WI (insert municipality and county, if county canvass insert county only) (type of election _ Election ( date of election) Office: Reporting Units: Candidates: Scattering (for Counties only) Total Votes Cast-Candidates: Total Votes Cast-Office: (For County Use Only) For a Partisan Primary, insert political party GAB-106 (Rev. 8/98-G.A.B. 12/09) Tabular - Board of Canvassers Report

Completing the Tabular Statement of Votes Cast Instructions For Municipal Canvass: x Write the name of your municipality, the kind of election - primary, spring, or special election, etc., and the date of the election in the heading. x Enter the complete name of the office with the seat or district number in the shaded area. x List the names of the candidates for the office in ballot order below the shaded area. x Make sure that all wards or ward combinations are listed in proper numerical order in the left hand column. The smallest number in a combination determines the order. (Example: Wards 1&4; Wards 2,6 & 7; and Wards 3&5.) x For each reporting unit, list the number of votes cast for each candidate.

x Don’t forget the write-in votes - they must be listed individually by name. x Enter the total number of votes cast for each candidate at the bottom of the column. Please give the total number of votes cast (not voters!) for each office in the “Total Votes Cast-Office” space. This total is the sum of the vote totals for each candidate plus the write-ins. Instructions For County Canvass: x Write the name of your county, the kind of election - primary, partisan primary, spring/general election, or special, etc., and the date of the election in the heading.

x A separate report must be completed for each political party in a partisan primary only. Write in the name of the political party on the line provided. x Enter the complete name of the office with the branch or district number in the shaded area. x List the names of the candidates for the office in ballot order below the shaded area. x Please list all municipalities and wards in the correct order in the left hand column. The smallest number in a combination determines the order. (Example: Wards 1&4; Wards 2,6 & 7; and Wards 3&5.) 1. Towns, alphabetically, wards numerically.

2. Villages, alphabetically, wards numerically. 3. Cities, alphabetically, wards numerically. x Make sure that all wards or ward combinations are listed along with the municipality name. If a municipality is divided by wards, but combines them for voting purposes and reports one total, you must still identify the numbers of the wards being reported. (Example: Town of Anywhere, Wards 1&2. If a municipality is not divided by wards do not list “Ward 1.”) x For each reporting unit, list the number of votes cast for each candidate. x Don’t forget the scattering column - if there are no write-in votes for a reporting unit, list 0. x Enter the total number of votes cast for each candidate at the bottom of the column. Please give the total number of votes cast (not voters!) for each office in the “Total Votes Cast-Office” space. This total is the sum of the vote totals for each candidate plus the scattering.

Notes for Municipal and County Clerks: Combining Reporting Units. A municipality may provide for combined wards by resolution up to 30 days* before the spring primary or election, if your population is under 35,000. It’s important to remember that for the spring primary and the spring election, wards in a municipality may be combined for judicial offices even though separate results may be required for county, municipal, or school district offices. The wards being combined must use the same polling place.

*60 days before a September Primary or General Election. Reporting for annexations requires special attention. As long as the area being annexed belongs to the same representative districts, i.e., congressional, legislative, and county supervisory districts, as the adjacent area to which it’s being annexed, then the annexed area is reported together with the adjacent area using the same ward number. But if the annexed area has different representative districts from its adjacent area or crosses county lines, the municipality is required by law to create a separate ward giving it the next consecutive number. All election results from this new ward must be reported under the new ward number.

GAB-106 Instructions, Board of Canvass Report

Certification of the Board of Canvassers We, the undersigned, certify that we are the members of the Board of Canvassers for . (insert municipality and county, if county canvass insert county only) We certify that the attached Tabular Statement of Votes Cast and Summary Statement of the Board of Canvassers, canvassed and prepared by us, are correct and true as compiled from the original returns made to the _ Clerk. (County, Municipal, School District) We further determine and certify that the following persons received the greatest and the next to greatest (for primary only) number of votes for the respective office for which each was a candidate on _ .

(Insert date of primary or election) SECOND OFFICE HIGHEST CANDIDATE HIGHEST CANDIDATE (For Primary Only) (Title of Office) (Name of Winning Candidate) (Name of Second Highest Candidate) BOARD OF CANVASSERS (1 _ _ (2 _ _ (3 _ _ (4 _ _ (5 _ _ (Date) This document is signed by: For a municipal election – The inspectors when there is only one polling place and one set of election results. s.7.53(1), Stats. For a municipal election – The municipal board of canvassers when there are 2 or more reporting units. s.7.53(2)(a), Stats. For state and county elections – The county board of canvassers. s.7.60(2), Stats.

GAB-106(Rev.8/98 – G.A.B. 12/09) Certification - Board of Canvassers Report

Summary Statement of the Board of Canvassers _ Election _ _ The total number of votes cast for _ was _ _ of which (insert office) received (candidate’s name) _ received _ _ (candidate’s name) _ received _ _ (candidate’s name) Scattering (for county only) received The total number of votes cast for _ was of which (insert office) _ received _ _ (candidate’s name) _ received _ _ (candidate’s name) _ received _ _ (candidate’s name) Scattering (for county only) received The total number of votes cast for _ was of which (insert office) _ received (candidate’s name) _ received (candidate’s name) _ received (candidate’s name) Scattering (for county only) received GAB-106(Rev.8/98-G.A.B.12/09) Summary Statement - Board of Canvassers Report

STATEMENT OF THE MUNICIPAL BOARD OF CANVASSERS Reconciliation of Late-Arriving and Provisional Ballots Processed (If no outstanding absentee ballots have been received and no provisional ballots have been rehabilitated, see the Municipal Clerk Certification on the last page of this document.) _ _ Reporting Unit _ _ (Date of Primary or Election) (Wards in Reporting Unit) To be completed by Municipal Clerk 1. Absentee Ballots a. Number of absentee ballots issued _ _ b. Number of absentee ballots processed on election night _ _ c. Number of absentee ballots outstanding on election night _ _ (1a – 1b) d. Number of outstanding absentee ballots returned by deadline and delivered to MBOC _ _ (tamper-evident seal number) e. Number of outstanding absentee ballots remaining _ _ (1c – 1d) 2. Provisional Ballots f. Number of provisional ballots issued _ _ (tamper-vident seal number) g. Number of provisional ballots rehabilitated by deadline and delivered to MBOC _ _ h. Number of outstanding provisional ballots remaining _ _ (2f – 2g) To be completed by MBOC 3. Absentee Ballot Processing a. Enter tamper-evident seal number on absentee ballot container _ _ Verify against number on line 1d above and initial here _ _ b. Enter the number of ballots in absentee container _ _ Verify against number on line 1d above and initial here _ _ c. Total number of absentee ballots counted by MBOC _ _ d. Total number of absentee ballots rejected by MBOC _ _ e. Total number of absentee ballots processed by MBOC _ _ (3c + 3d. Must equal 3b) 4. Provisional Ballot Processing a. Enter tamper-evident seal number on provisional ballot container _ _ Verify against number on line 2f above and initial here _ _ b. Total number of provisional ballots counted by MBOC _ _ c. Total number of provisional ballots rejected by MBOC _ _ d. Total number of provisional ballots processed by MBOC _ _ (4b + 4c. Must equal 2g.) GAB-106/AP | 2015-08 | Government Accountability Board, P.O. Box 7984, Madison, WI 53707-7984 | 608-261-2028 | web: gab.wi.gov | mail: gab@wi.gov

STATEMENT OF TALLY OF LATE-ARRIVING ABSENTEE BALLOTS AND PROVISIONAL BALLOTS _ _ (Date of Primary or Election) The total number of votes tallied for _ was , of which (insert office) received _ _ (candidate’s name) _ received _ _ (candidate’s name) _ received _ _ (candidate’s name) _ received _ _ (candidate’s name) The total number of votes tallied for _ was , of which (insert office) _ received _ _ candidate’s name) _ received _ _ (candidate’s name) _ received _ _ (candidate’s name) _ received _ _ (candidate’s name) The total number of votes tallied for _ was , of which (insert office) _ received _ _ (candidate’s name) _ received _ _ (candidate’s name) _ received _ _ (candidate’s name) _ received _ _ (candidate’s name) The total number of votes tallied for _ was , of which (insert office) _ received _ _ (candidate’s name) _ received _ _ (candidate’s name) _ received _ _ (candidate’s name) _ received _ _ (candidate’s name) 2 GAB-106/AP | 2015-08 | Government Accountability Board, P.O. Box 7984, Madison, WI 53707-7984 | 608-261-2028 | web: gab.wi.gov | mail: gab@wi.gov

CERTIFICATION OF MUNICIPAL BOARD OF CANVASSERS We, the undersigned, certify that we are the members of the Municipal Board of Canvassers for . (insert municipality and county) We certify that the above Reconciliation of Ballots Processed and the attached Statement of Tally of Late-Arriving Absentee Ballots and Provisional Ballots prepared by us, are correct and true as compiled from the absentee and provisional ballots provided to us by , Clerk. (Name of Municipal Clerk) BOARD OF CANVASSERS (1 _ _ (2 _ _ (3 _ _ (4 _ _ ( 5 _ _ (Date) The Statement of the Municipal Board of Canvassers should be attached to the amended municipal canvass (if there were municipal offices or referenda). A copy should be included with amended returns sent to any district that had contests or referenda on the ballot at the election. 3 GAB-106/AP | 2015-08 | Government Accountability Board, P.O. Box 7984, Madison, WI 53707-7984 | 608-261-2028 | web: gab.wi.gov | mail:gab@wi.gov

STATEMENT OF THE MUNICIPAL CLERK Reconciliation of Late-Arriving and Provisional Ballots Processed _ Reporting Unit _ _ (Date of Primary or Election) (Wards in Reporting Unit) ˆNo absentee ballots were returned and no provisional ballots rehabilitated. Election night results stand. *CERTIFICATION OF MUNICIPAL CLERK (If no outstanding absentee ballots received or provisional ballots rehabilitated by deadline) I, the undersigned, certify that I am the Municipal Clerk for . (insert municipality and county) I certify that no outstanding absentee ballots were received nor provisional ballots rehabilitated after the close of the polls and before 4 p.m. on the Friday after the election. I further certify that the results of the municipal election certified on Election Night by the Municipal Board of Canvassers are the official election results.

, Clerk _ _ (Name of Municipal Clerk) (Date) The Statement of the Municipal Clerk should be attached to the municipal canvass (if there were municipal offices or referenda). A copy should be provided to any district that had contests or referenda on the ballot at the election. 4 GAB-106/AP | 2015-08 | Government Accountability Board, P.O. Box 7984, Madison, WI 53707-7984 | 608-261-2028 | web: gab.wi.gov | mail: gab@wi.gov

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Official Oath STATE OF WISCONSIN, ) ) ss _ County) I , having been elected or appointed to the office of _ _ (title) swear (or affirm) that I will support the constitution of the United States and the constitution of the State of Wisconsin, and will faithfully and impartially discharge the duties of said office to the best of my ability. So help me God. _ _ (Signature of elected or appointed official) Subscribed and sworn to before me this _ day of _ . _ _ (Signature of person authorized to administer oaths) My commission expires , or is permanent Notary Public , or _ _ (Official title, if not a notary) GAB-154 (12/09) The information on this form is required by Article IV, Section 28 of the Wisconsin Constitution, §. 19.01 (1), (lm), Wis. Stats. This form is prescribed by the Government Accountability Board, P.O. Box 7984, Madison, WI 53707-7984, 608-266-8005, gab@wi.gov http://gab.wi.gov.

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