State of South Dakota - Statement of Orqanization Candidates, Political Action or Ballot Question Committees Full Name of Committee:

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listthe name, streetaddress, postaladdress and telephone numberofeach 6nancial institution where an account or depository

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maintained by or for the benefit of the filing organization. Nam€ of Flnendal Instltutlon

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Name ofTteasurer

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Treasurer sEe€t Addre6s

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Trcasurer Postal Address

Treasurer E-Mail Address

Trearu.er Daytime telephone

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State law requires statewide and legislative candidate committeet political actbn committees (PAC) and ballot question committe6 to register with the Secretary of State. Candklate committees must register within ffieen days after becoming a candidate. Candidate committees that have not already filed a staternent of organization, PACS and ballot que6tbn committees must register not later than f!fteen days after the date upon whkh the committee rnade contributiont received contributions or pakl expenses in excess of five hundred dollars unless such activity falls within thirty days of any statewile election in which case the statement of orga nization shall be filed wlthin forty-eight hours.

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VERIFICATION OF PERSONS MAKING REPORT

(print both names legibly). certify that we have examined We this stat6ment and to the best of our kn/owledge and belief it is true, correct and complete. We also understand that fallure to tlmely fileany statement, amendment, or correction required subjects the treasurer responsible for filing to a civil penalty of fifty dollars per day for each day that the statement remains delinquent.

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The candidate or treasurel of a political committee shall file an updated statement of organization not later than fifteen days after any change in the information containd on the most recently filed statement of organization.

County, municipal and school candidates file with the person in charge of the local election. Statewide and legislative candidate committeet political action committees (PAC) and ballot question committees to register with the Secretary of State at:

Secretary of State, Elections Department 5(x, Eart Cap:tol Ave., Ste 2(H Pierre,SD 575O1 or fax to 605-773{58[t or e-mail to [email protected] s Fax and email images must contain the signature(s) and the original must be filed in our office within one week following the date the faVemail was received.

For Offrce Use Only: