Fillable CommunicationExpendituresFillable State of South Dakota

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CommunicationExpendituresFillable State of South Dakota

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Last updated October 3, 2019
COMMUNICATION EXPENDITURE
SDCL 12-27-16 and SDCL 12-27-16.1
STOP! File online at https://sdcfr.sdsos.gov/
Who files this statement: Any PERSON or ENTITY that makes a payment or promise of payment totaling more than
$100.00, including donated goods or services for a communication expenditure that concerns a candidate, public office
holder, ballot question, or political party. SDCL 12-27-16(a)-(e) outlines what types of communications do not need to
be reported on this form. POLITICAL COMMITTEES list Communication Expenditures on their Campaign Finance
Disclosure Form.
Deadline to file: Within 48 hours of the time that the communication is disseminated, broadcast, or otherwise published.
File with: The Secretary of State except local political committees file with their local election official.
Disclaimers for communications: follow SDCL 12-27-16 (1) (a)-(c) and 12-27-16.1
Please print below (all fields are required):
_________________________________________________________________________________________________
Name of Person or Entity
_________________________________________________________________________________________________
Complete Mailing (PO Box or Street) Address City, State and Zip Code
_________________________________________________________________________________________________
Website Address of Entity (if applicable)
_________________________________________________________________________________________________
Name and Title of Person Filing the Report for the Entity
_________________________________________________________________________________________________
Name of Person who Authorized the Expenditures on Behalf of the Entity
_________________________________________________________________________________________________
Name of Chief Executive (if any) of the Entity
List the NAME(S) of each candidate, public office holder, ballot question, or political party mentioned or identified in each
communication, the AMOUNT SPENT on each communication, a DESCRIPTION of the content of each communication
and the date the communication was disseminated.
NAME
COMMUNICATION TYPE & DESCRIPTION
AMOUNT SPENT
DATE
Check the box below to identify if the communication was made with or without consultation:
This communication clearly identified a candidate, public office holder, ballot question, or political party
BUT WAS NOT controlled by, coordinated with, requested by, or made upon consultation with that candidate,
political committee, or agent of a candidate or political committee.
This communication clearly identified a candidate, public office holder, ballot question, or political party
AND WAS MADE upon consultation with that candidate, political committee, or agent of a candidate or political
committee.
Last updated October 3, 2019
(1). For an entity whose majority ownership is owned by, controlled by, held for the benefit of, or comprised of twenty or
fewer persons, partners, owners, trustees, beneficiaries, participants, members, or shareholders, the statement shall
identify by name and mailing address each person, partner, owner, trustee, beneficiary, participant, shareholder, or
member who owns, controls, or comprises ten percent or more of the entity. (SDCL 12-27-16 (4))
Name of each person, partner, etc.…
Mailing (PO Box or Street) Address
City, State and Zip Code
* Please include extra communication expenditure sheets if more space is needed.
(2). An entity shall also provide statements for any of its partners, owners, trustees, beneficiaries, participants, members, or
shareholders identified pursuant to (1) above, which are owned by, controlled by, held for the benefit of, or comprised of
twenty or fewer persons, partners, owners, trustees, beneficiaries, participants, members, or shareholders, until no entity
identified in the statements meets the ownership test set forth above. (SDCL 12-27-16 (5))
Name Street Address, City, State and Zip Code
* Please include extra communication expenditure sheets if more space is needed.
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
).
Penalties not to exceed $250 could be assessed per SDCL 12-27-29.4.
DATE:
PRINTED NAME (of person filing the report)
SIGNATURE (of person filing the report)
Secretary of State’s Office • Elections Division
500 E. Capitol Ave., Ste. 204 • Pierre, SD • 57501
Office 605-773-3537 • Fax 605-773-6580 • Email cfr@state.sd.us
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Completed 3 July 2020

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