CONDUIT CAMPAIGN FINANCE REPORT

							                                   CONDUIT CAMPAIGN FINANCE REPORT
                                                        STATE OF WISCONSIN
 CONDUIT IDENTIFICATION
 Name of Conduit Fund                                                                                 GAB ID Number ______________
 Street Address                                                                                                Is This Report An Amendment?
                                                                                                                        Yes             No
 City, State, and Zip Code                                                                            Is Address Different Than Previously Reported?
                                                                                                                       Yes              No

 NAME OF REPORT
                January Continuing ____               Pre-Primary ____                Spring              Fall               Special Election
                                                                                                                                     Office ________

                July Continuing ____                  Pre-Election ____                Spring             Fall               Special Election
                                                                                                                                     Office ________

                                                                                        GAB ID Number of            Column A              Column B
                             Complete Name and Address of Registrant                       Receiving               Amount This            Calendar
     Date                       to Whom Funds Were Transferred                            Committee                  Period              Year-to-Date




                                SUBTOTAL CONTRIBUTIONS THIS PAGE

               TOTAL CONTRIBUTIONS GIVEN THIS REPORT PERIOD
        TOTAL CONTRIBUTIONS RETURNED THIS REPORT PERIOD

I, ______________________________________________, certify that the information in this report is true and complete.
                             (Print full name)
____________________________________________                                  ______________________                             _________________
                       (Signature of Administrator)                                  (Daytime phone)                                      (Date)

The information on this form is required by ss.11.06, 11.20, Stats. Failure to provide the information may subject you to the penalties of ss.11.60, 11.61,
11.66, Stats.
                                                                                                 rd
This form is prescribed by the GOVERNMENT ACCOUNTABILITY BOARD, 212 E. Washington Ave, 3 Floor, P.O. Box 7984, Madison, WI 53707-7984.
(608) 266-8005 Fax: (608) Website: http://cfis.wi.gov E-mail: gabcfis@wi.gov
EB-10 (Rev.4/09)
              Instructions for Reporting Conduit Transfers
             (if under $20,000 per biennium AND not filing electronically)
1. Conduits that transfer contributions to candidates, personal campaign committees, legislative
   campaign committees, or political party committees are subject to registration and reporting
   requirements.
2. Conduits are required to file campaign finance reports at the times specified in s.11.20, Stats. The
   Government Accountability Board has determined that these reports shall consist of:
    a. Two (2) copies of the dated transmittal letters (required by s.11.06(11)(a), Stats.). One copy
        will be placed in the file of the registrant receiving the transferred contribution. (See #3 below.)
    b. A summary report listing the date of the transfer, complete name and address of each recipient,
        total amount transferred to each recipient in this report period (Column A), and the total amount
        transferred during the calendar year (Column B).
    c. A returned contributions schedule (EB-10 Returns) when applicable. (See #4 below.)

3. All contributions transferred by a conduit must be accompanied by a dated transmittal letter. The
   transmittal letter shall contain:
    a. A statement clearly identifying that the contribution is from a conduit.
    b. The name and address of the recipient to whom contributions are transferred, the date the
       transfer was made, and the total amount transferred.
    c. The complete name and address of each individual contributor and the amount of his or her
       contribution regardless of the amount. The total of all individual contributions reported must
       equal the total transfer.
    d. The contributor’s occupation and complete name and address of the principal place of
       employment, when an individual’s total contributions to the same recipient exceed $100
       cumulatively in the calendar year.
4. If a contribution is returned, lost, or not cashed for other reasons, report these items on the
   Contributions Returned From Candidates and Committees (EB-10 Returns). List the name and
   address of the recipient committee, date of the original contribution, the date it was returned (or you
   stopped payment on the check), and the amount of the transfer.
5. A conduit must file a Pre-Primary or Pre-Election Report only when a contribution is transferred to
   a candidate who is in the election during that report period.
6. A conduit must file a Special Report of Late Contribution for Conduits (EB-4) if it transfers $500 or
   more to a candidate during the 15-day period prior to the Primary or Election, either in one
   transaction or cumulatively over the 15-day period.
7. If no contributions are transferred in a continuing report period (January 1-June 30, July 1-December 31), the
   conduit may file the Postcard Report Form (EB-10a) indicating no contributions during the report
   period.

The information on this form is required by ss.11.06, 11.20, Stats., ElBd. 1.85, Wis. Adm. Code.
This form is prescribed by the GOVERNMENT ACCOUNTABILITY BOARD, 212 E. Washington Ave, 3rd Floor, P.O. Box 7984, Madison, WI
53707-7984 608-266-8005.