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CAMPAIGN REGISTRATION STATEME~ KEf;: COUNT

STATE OF WISCONSIN
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ELI~l~lt1!;1!~rJoNLY
GAB-l
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IF A CANDIDATE DOES NOT FILE TIllS STATEMENT BY TIlE DEADLINE FOR FILING NOMINATIO.....
2009 NOV '0 AMcD
ll; 55
•..
TIlE CANDIDATE'S NAME WILL NOT BE PLACED ON TIlE BALLOT·RE t.1 V •• C
NOTICE: ANY CHANGE OF INFORMATION ON TIllS REGISTRATION STATEMENT MUST BE FILED WITIllN 10 DAYS.

IS 1HIS AN AMENDMENT? 0 Yes lXI No


1. CANDIDATE AND CANDIDATE COMMITTEE INFORMATION
Name of Candidate party Affiliation Office Sought (include district or branch number)

Residence Address (number and street) PrimaIy Date Candidate Telephone Number (residenCll)
-

City, State and Zip Code Election Date Candidate Telephone Number (employment)

Check One: [J Personal Campaign Committee [J Support Committee Candidate Email Address (optional)
Campaign Committee Name (if any)

Campaign Committee Address (if different than above) - Number, Street, City, State and Zip Code

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

No-r;; (
Address - Number, Street, City, State and Zip Code

141. c_ ~~~\Le\
Telephone Number

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Sponsoring Organization - Name and Complete Address

Type of Committee:
A. C!1. Special Interest Committee (pAC)
llQ Resident Committee [J Nomesident Committee
o Incorporated Labor Organization - Attach Information Required by s.ll.05(3)(n), Stats.
B. 0 Political Party Committee
o National [J State [J County 0 Other _
C. 0 Legislative Campaign Committee - Attach Statement Required by s.II.05(3)(0), Stats.

D. [J Political Group (Referendum) _


Name of Referendum
E. 0 Recall Committee _
Name of Officer SlIIbject to Recall
• Attach Statement Required by s.9.1 O(2)(d)
F. 0 Independent Committee - Also, Complete Oath of Independent Expenditures, Form EB-6
G. [J Individual - Also, Complete Oath of Independent E ditures, Form EB-6

GAB-I (Rev. 0912009) TIDS FORM IS PRESCRIBED BY: WISCONSIN GOVERNMENT ACCOUNTABILITY BOARD
212 East Washington Avenue, 3'" Floor, P.O. Box 7984, Madison, WI 53707·7984
608-266-8005 http://gab.wi.gID'. Email: gab@wLgnv
3. COMMITTEE TREASURER (Campaign fmance correspondence is mailed to this address.)
Treasurer's Name Telephone Number (residence)

-\Dcv \ C\\1- 3q~-\~?-'


Address (number and street) Telephone Number (employment)

~ 1 ~ 7.. ~. \J..)~~c...\u.('
City, State and Zip Code

c...~)~ \,>J \ ? 3\ \ ()
4. PRINCIPAL OFFICERS OF COMMITTEE AND OTHER CUSTODIANS OF BOOKS AND ACCOUNTS
Attach additional listing if necessary. fudicate which officers or committee members are authorized to ftll 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 of Financial fustitution Account Number (Attach list of any additional accounts and deposit boxes, location, type and nmnber, i.e.,
savings, checking, money market, etc.)

Address (number and street) City, State and Zip Code

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.

You may be eligible for an exemption from filing campaign fmance 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.

_, () . 3) -oj
Date

THE ORMATION 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.
HI.LWAljKEE CQUN •Y
CAMPAIGN REGISTRATION STATEMENT ELECTION COHMIS fON
STATE OF WISCONSIN
GAB-l
IF A CANDIDATE DOES NOT FILE THIS STATEMENT BY THE DEADLINE FOR FlUNG NOMINATION p~~
THE CANDIDATE'S NAME WILL NOT BE PLACED ON THE BALLOT.
E I V Ii 0

IS TillS AN AMENDMENT? 0 Yes


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: o Personal Campaign Committee o Support Committee Candidate Email Address (optional)

Campaign Committee Address (if different than above) - Number, Street, City, State and Zip Code

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

(; (~t-\Jb.1£.

Type of Committee:
A. ,9( Special Interest Committee (PAC)
..s Resident Committee 0 Nonresident Committee
o Incorporated Labor Organization - Attach Information Required by s.II.05(3Xn), Stats.
B. 0 Political Party Committee
o National 0 State 0 County 0 Other _
C. 0 Legislative Campaign Committee - Attach Statement Required by s.11.05(3)(o), Stats.

,.r
Name of Referendum

Name of Officer Subject to Recall


- Attach Statement Required by s.9.10(2)(d)
F. 0 Independent Committee - Also, Complete Oath ofIndependent Expenditures, Form EB-6
G. 0 Individual- Also, Complete Oath of Independent Expenditures, Form EB-6

GAB-I (Rev. 09/2009) TillS FORM IS PRESCRIBED BY: WISCONSIN GOVERNMENT ACCOUNTABILITY BOARD
212 East Washington Avenue, 3'" Floor, P.O. Box 7984, Madison.. WI 53707-7984
608-266-8005 http://gab.wi.gov Emai1: gab@wi.gov
(E)..J/)4~- tvX. It/Ii /Of <Air:
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 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

(print full name) certify the information in this statement is true, correct and complete.

. Treasurer
~
II / /I I(0 -f----------
a

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.

You may be eligible for an exemption from filing campaign fmance 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, exceph:ontributions by a candidate to his or her campaign of $1,000 or less in a calendar
year.

LJ Thi~O Iff ::thIn daim to exemption.

Signature of Candidate or Treasurer

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.