NCMINA1ICN ALk ICk INDLLNDLN1 CANDIDA1LS ICk GCVLkNCk AND LILU1LNAN1 GCVLkNCk

!"#$%&"% candldaLe's name, no LlLles may be used. '() !"#$%&"% candldaLe's name, no LlLles may be used
SLreeL, flre or rural rouLe number, box number (lf rural rouLe), and name of sLreeL or road SLreeL, flre or rural rouLe number, box number (lf rural rouLe), and name of sLreeL or road
name and Lype of munlclpallLy for voLlng purposes.
! 1own of
! vlllage of
! ClLy of
name of munlclpallLy for malllng
purposes
SLaLe
Wl
Zlp code name and Lype of munlclpallLy for voLlng purposes.
! 1own of
! vlllage of
! ClLy of
name of munlclpallLy for malllng
purposes
SLaLe
Wl
zlp code
Ceneral LlecLlon uaLe name of arLy of SLaLemenL of rlnclple (3 words or less)
l, Lhe underslgned, requesL LhaL Lhe candldaLe, whose name and address are llsLed above, be placed on Lhe balloL aL Lhe elecLlon descrlbed above as a candldaLe represenLlng Lhe parLy or sLaLemenL of
prlnclple lndlcaLed above, so LhaL voLers wlll have Lhe opporLunlLy Lo voLe for Lhem for Lhe offlces of Covernor and LleuLenanL Covernor. l am ellglble Lo voLe ln Lhe State of W|scons|n. l have noL slgned Lhe
nomlnaLlon paper of any oLher candldaLe for Lhe same offlce aL Lhls elecLlon.
1he mun|c|pa||ty used for ma|||ng purposes, when d|fferent than mun|c|pa||ty of res|dence, |s not suff|c|ent. 1he name of the mun|c|pa||ty of res|dence must a|ways be ||sted.
S|gnatures of L|ectors r|nted Name of L|ectors Street and Number or kura| koute
kura| address must a|so |nc|ude box or f|re no
Mun|c|pa||ty of kes|dence
rov|de name of mun|c|pa||ty
Date of S|gn|ng
1.

! 1own
! vlllage
! ClLy


2.

! 1own
! vlllage
! ClLy



3.

! 1own
! vlllage
! ClLy



4.

! 1own
! vlllage
! ClLy



3.

! 1own
! vlllage
! ClLy



6.

! 1own
! vlllage
! ClLy
! ClLy



7.

! 1own
! vlllage
! ClLy



8.

! 1own
! vlllage
! ClLy



9.

! 1own
! vlllage
! ClLy
! ClLy



10.

! 1own
! vlllage
! ClLy



CLk1IIICA1ICN CI CIkCULA1Ck
l, , cerLlfy: l reslde aL ____________________________________________________________.

(name of clrculaLor) (ClrculaLor's resldence - Inc|ude number, street, and mun|c|pa||ty.)
l furLher cerLlfy l am elLher a quallfled elecLor of Wlsconsln, or a u.S. clLlzen, age 18 or older who, lf l were a resldenL of Lhls sLaLe, would noL be dlsquallfled from voLlng under Wls. SLaL. 6.03. l personally clrculaLed Lhls nomlnaLlon paper and
personally obLalned each of Lhe slgnaLures on Lhls paper. l know LhaL Lhe slgners are elecLors of Lhe [urlsdlcLlon or dlsLrlcL Lhe candldaLe seeks Lo represenL. l know LhaL each person slgned Lhe paper wlLh full knowledge of lLs conLenL on Lhe daLe
lndlcaLed opposlLe hls or her name. l know Lhelr respecLlve resldences glven. l lnLend Lo supporL Lhls candldaLe. l am aware LhaL falslfylng Lhls cerLlflcaLlon ls punlshable under Wls. SLaL.
12.13(3)(a).
_____________________________________ ___________________________________________________________
(uaLe)
(SlgnaLure of clrculaLor)
GAB-166 | Rev. 2014-04 | Government Accountability Board, P.O. Box 7984, Madison, WI 53707-7984 | 608-261-2028 | web: gab.wi.gov | email: gab@wi.gov
age no.
Francis Joseph Klein
November 4th, 2014 The Wisconsin Pirate Party (WIPP)
130 Lathrop St. Apt. 3
Madison Madison 53726
INS1kUC1ICNS ICk kLAkING NCMINA1ICN ALkS ICk Ak1ISAN CIIICL

1hls ls a sample nomlnaLlon paper form. lL conforms Lo Lhe sLaLuLory requlremenLs for nomlnaLlon papers for parLlsan offlce. All lnformaLlon concernlng Lhe candldaLe musL be compleLed ln full before
clrculaLlng Lhls form Lo obLaln slgnaLures of elecLors. All lnformaLlon concernlng Lhe slgnlng elecLors and Lhe clrculaLor musL be compleLed ln full before flllng wlLh Lhe approprlaLe flllng offlcer. 1hls
form may be reproduced ln any way. A candldaLe's plcLure and campalgn lnformaLlon may also be added Lo Lhls form. 1he CovernmenL AccounLablllLy 8oard (C.A.8.) has deLermlned LhaL no dlsclalmer
or oLher aLLrlbuLlon sLaLemenL ls requlred on nomlnaLlon papers. CandldaLes are advlsed Lo send a sample of Lhelr compleLed form Lo Lhe flllng offlcer for revlew before clrculaLlon. lederal and sLaLe
candldaLes flle wlLh Lhe C.A.8. CounLy candldaLes flle wlLh Lhe CounLy Clerk.

+,-$ ./01$%2 - number each page consecuLlvely, beglnnlng wlLh 1", before submlLLlng Lo Lhe flllng offlcer. A space for page numbers has been provlded ln Lhe lower rlghL-hand corner of Lhe form.
3,&454,($62 .,0$ - lnserL Lhe candldaLe's name. A candldaLe may use hls or her full legal name, or any comblnaLlon of flrsL name, mlddle name, and lnlLlals or nlckname wlLh lasL name. 1he
CovernmenL AccounLablllLy 8oard has deLermlned LhaL, absenL any evldence of an aLLempL Lo manlpulaLe Lhe elecLoral process, candldaLes are permlLLed Lo choose any form of Lhelr name, lncludlng
nlcknames, by whlch Lhey wanL Lo appear on Lhe balloL.
no LlLles are permlLLed. ln addlLlon, names such as 8ed" or Sklp" are permlLLed, buL names LhaL have an apparenL elecLoral purpose or beneflL, such as Lower Laxes," none of Lhe above" or Lower
Spendlng" are noL permlLLed. lL ls also noL permlsslble Lo add nlcknames ln quoLes or parenLheses beLween flrsL and lasL names. lor example, !ohn !ack" !ones or !ohn (!ack) !ones are noL accepLable,
buL !ohn !ones, !ack !ones or !ohn !ack !ones are accepLable.
3,&454,($62 7$254$&8$ - lf a candldaLe's munlclpallLy of resldence ls dlfferenL from Lhe munlclpallLy used for malllng purposes, boLh musL be glven. lndlcaLe lf Lhe munlclpallLy of resldence ls a Lown,
vlllage or clLy.
9,($ ": !$&$%,; <;$8(5"& - lnserL Lhe daLe of Lhe elecLlon, whlch ls Lhe 1uesday afLer Lhe flrsL Monday ln november of an even-numbered year.
+,%(= "% >(,($0$&( ": +%5&85?;$ - lnserL Lhe name of Lhe parLy Lhe candldaLe represenLs. lndependenL candldaLes may provlde a SLaLemenL of rlnclple, noL Lo exceed 3 words.
>5-&,(/%$2 ,&4 +%5&($4 .,0$2 ": <;$8("%2 - Cnly quallfled elecLors of Lhe SLaLe of Wlsconsln slgn Lhe nomlnaLlon papers. Lach slgner musL also leglbly prlnL Lhelr name. Lach elecLor's
munlclpallLy of resldence musL be llsLed on Lhe nomlnaLlon paper along wlLh Lhe malllng address, lncludlng any sLreeL, flre or rural rouLe number, box number (lf rural rouLe) and sLreeL or road name. 1he
SLreeL & number or 8ural 8ouLe secLlon for each elecLor's address ls spllL lnLo Lwo llnes. 1he flrsL llne ls for Lhe sLreeL address. 1he second llne ls for Lhe munlclpallLy for malllng purposes. 1he
MunlclpallLy of 8esldence llsLed for each slgnlng elecLor musL clearly ldenLlfy Lhe Lown, vlllage or clLy where Lhe elecLor's voLlng resldence ls locaLed. A posL offlce box number alone does noL show where
Lhe elecLor acLually resldes. 1he daLe Lhe elecLor slgned Lhe nomlnaLlon paper, lncludlng monLh, day and year, musL be lndlcaLed. ulLLo marks LhaL follow correcL and compleLe address or daLe
lnformaLlon are accepLable. 1he clrculaLor may add any mlsslng or llleglble address or daLe lnformaLlon before Lhe papers are flled wlLh Lhe flllng offlcer.
>5-&,(/%$ ": 35%8/;,("% - 1he clrculaLor should carefully read Lhe language of Lhe !"#$%&%'($%)* )& !%#',-($)#. 1PL Cl8CuLA1C8 MuS1 L8SCnALL? 8LSLn1 1PL nCMlnA1lCn AL8 1C LACP SlCnL8. 1nL NCMINA1ICN
ALk MA NC1 8L LLI1 UNA11LNDLD CN CCUN1LkS Ck CS1LD CN 8ULLL1IN 8CAkDS. 1he clrculaLor's compleLe address musL be llsLed ln Lhe cerLlflcaLlon. AfLer obLalnlng slgnaLures of elecLors, Lhe clrculaLor musL slgn
and daLe Lhe cerLlflcaLlon.
@(A$% B&2(%/8(5"&2 - CandldaLes and clrculaLors should revlew Ch. CA8 2.03, 2.07, Wls. Adm. Code.
" .#%/%*(- nomlnaLlon papers musL be ln Lhe physlcal cusLody of Lhe approprlaLe flllng offlcer by Lhe flllng deadllne. A posLmark on Lhe flllng deadllne ls NC1 sufflclenL. nomlnaLlon papers cannot
be faxed/emalled Lo Lhe flllng offlcer. Ch. CA8 6.04(2), Wls. Adm. Code.
" nomlnaLlon papers wlLh Lhe requlred number of slgnaLures musL be flled wlLh Lhe approprlaLe flllng offlcer no |ater than S:00 p.m. on !une 1
sL
(or Lhe nexL day lf !une 1
sL
ls a hollday or
weekend) before Lhe general elecLlon. nomlnaLlon papers may noL be clrculaLed before Aprll 13. Speclal elecLlons may have dlfferenL clrculaLlon Llme frames and flllng deadllnes. Check wlLh
Lhe flllng offlcer.
" ln order for a candldaLe's name Lo be placed on Lhe balloL, a candldaLe musL flle a !(01(%/* 2"/%3$#($%)* 4$($"0"*$ (CA8-1), a 5"'-(#($%)* )& !(*6%6('7 (CA8-162), and 8)0%*($%)* 9(1"#3
(CA8-166) conLalnlng Lhe approprlaLe number of slgnaLures for Lhe offlce soughL no laLer Lhan Lhe flllng deadllne. Wls. SLaL. 8.13(6). CandldaLes for sLaLe offlce and munlclpal [udge musL also
flle a SLaLemenL of Lconomlc lnLeresLs wlLh Lhe CovernmenL AccounLablllLy 8oard by Lhe Lhlrd buslness day afLer Lhe nomlnaLlon paper flllng deadllne. Wls. SLaL. 19.43. lf any one of Lhese
requlred forms ls noL flled by Lhe deadllne, Lhe candldaLe's name wlll noL be placed on Lhe balloL. Wls. SLaL. 8.30.
" lf a candldaLe or clrculaLor has any quesLlons, he or she should conLacL Lhe CovernmenL AccounLablllLy 8oard.


GA8-166 lnsLrucLlons (8ev. 2014-04)