Registration

The Treasurer for a political committee shall file a statement of organization not later than 15 days after the date upon which the committee made contributions, received contributions, or paid expenses in excess of $500.00. However, if such activity falls within 30 days of any statewide election, the statement of organization shall be filed within 48 hours. A candidate shall file a statement of organization for a candidate campaign not later than 15 days after becoming a candidate (SDCL 12-27-3; SDCL 12-27-23). The treasurer of a political committee shall file an updated statement of organization not later than fifteen days after ANY change in the information on this statement.

If you are required to file with your local jurisdiction (county, school or municipality: candidate, ballot question committees and PACs) contact your local election official for the necessary form(s).

If you are submitting this Statement to the Secretary of State's office choose a Committee Type below.

Committee Type (you must select one):

Auxiliary Political Party

County Political Party

Statewide Political Party

Statewide Ballot Question Committee

Statewide Political Action Committee (PAC)

Statewide Candidate Committee

Legislative Candidate Committee

Committee Information

(ALL fields required unless indicated otherwise):

only ONE candidate campaign committee may be organized for each candidate (SDCL 12-27-1 (3))
Exception: a candidate can have both a statewide and legislative committee.

Full Name of Committee	*
Telephone Number	*

Committee Mailing Address	*
City	*	State	State --- South Dakota Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming *	Zip	* *
Check here if the Committee Mailing and Street Addresses are the same
Committee Street Address	*
City	*	State	State --- South Dakota Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming *	Zip	* *
Committee website address (optional)

Chair (Candidate can serve as Chair of their Committee)
First Name	*	Last Name	*
Telephone Number	*					Evening Phone Number	*
Mailing Address	*
City	*	State	State --- South Dakota Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming *	Zip	* *
Check here if the Chairperson Mailing and Street Addresses are the same
Street Address	*
City	*	State	State --- South Dakota Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming *	Zip	* *
Email Address	* *
Email Address (again to confirm)	* *
Check here if this committee will have a co-chair

Check this box if Chair is also serving as Treasurer. If the same, you will not fill out the Treasurer fields.
*The Treasurer is responsible for filing all campaign finance reports and forms. Letters and notices, sent by the Secretary of State’s office, will go to the Treasurer only.
Treasurer*
First Name	*	Last Name	*
Telephone Number	*					Evening Phone Number	*
Mailing Address	*
City	*	State	State --- South Dakota Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming *	Zip	* *
Check here if the Treasurer Mailing and Street Addresses are the same
Street Address	*
City	*	State	State --- South Dakota Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming *	Zip	* *
Email Address	* *
Email Address (again to confirm)	* *

Verification below must be ACKNOWLEDGED BEFORE SUBMITTING this Statement

No person may execute this report knowing it is false in any material respect. Any violation may be subject to a civil and/or criminal penalty. Any person who, with intent to defraud, falsely makes, completes, or alters a written instrument of any kind, or passes any forged instrument of any kind is guilty of forgery. Forgery is a Class 5 felony (SDCL 22-39-36). I also understand that failure to timely file any statement, amendment, or correction required subjects the Treasurer, who is responsible for filings under SDCL 12-27, to a civil penalty of $200.00 (county political parties and auxiliary organizations, $50.00) for each violation (SDCL 12-27-29.1). Additional penalties not to exceed $250.00 could be assessed per SDCL 12-27-29.4. I also understand that failure to timely file reports or pay penalties could result in the candidate not being certified for office (SDCL 12-27-29.3).

Please check this box to acknowledge that you have read the above statement, which, for purposes of online filing,
will count as a signature.

		(Treasurer),
		(Chair or Candidate),

Date:
			Signature of Treasurer
Date:
			Signature of Chair or Candidate

12-27-49. Effect of secretary of state's filing or refusing to file document. The Office of the Secretary of State's duty to file a document under this chapter is ministerial. If the Office of the Secretary of State files or refuses to file a document, it does not:
    (1) Affect the validity or invalidity of the document in whole or part;
    (2) Relate to the correctness or incorrectness of information contained in the document; or
    (3) Create a presumption that the document is valid or invalid or that information contained in the document is correct or incorrect.

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MONAE L. JOHNSON

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Statement of Organization