8/11/2019 CJF-Oath of Indepdent Disbursements

1/2

OATH FOR COMMITTEES, INDIVIDUALS AND INDEPENDENT

COMMITTEE MAKING INDEPENDENT DISBURSEMENTS

STATE OF WISCONSIN

GAB-6

OFFICE USE ONLY

1. COMMITTEE, INDIVIDUAL OR INDEPENDENT DISBURSEMENT COMMITTEE MAKINGINDEPENDENT DISBURSEMENTS

LIST ALL CANDIDATES WHO WILL BE SUPPORTED OR OPPOSED BY THE INDEPENDENTDISBURSEMENTS. ATTACH ADDITIONAL SHEETS IF NECESSARY.

3.

THIS FORM IS PRESCRIBED BY THE WISCONSIN GOVERNMENT ACCOUNTABILITY BOARD, P.O. BOX 7984, MADISON, WI 53707-7984PHONE: 608-261-2028 | FAX: 608-264-9319 | WEB: https://cfis.wi.gov | EMAIL: GABCFIS@wi.gov

THE INFORMATION ON THIS FORM REQUIRED BY s. 11.06(7), WIS STATS. FAILURE TO PROVIDE THE INFORMATION MAY SUBJECTYOU TO THE PENALTIES OF ss. 11.06, 11.61, 11.66, WIS. STATS.

Pursuant to s. 11.06(7), Stats., I,

(Signature of Individual, Treasurer or Agent)

STATE OF WISCONSIN

COUNTY OF

Subscribed and sworn to (affirmed) before me this day of

( Notary Public or Person Authorized to Administer Oaths)

My Commission expires (For Notary Only)

,

being duly sworn, state that with respect to independent disbursements in support of the candidates listed (thecommittee / independent disbursement committee does not) (I do not) act in cooperation or consultation with anycandidate or agent or authorized committee of a candidate who is supported and (the committee / independentdisbursement committee does not) (I do not) act in concert with or at the request or suggestion of any candidate orany agent or authorized committee of a candidate who is supported. (The committee/ independent disbursementcommittee does not) (I do not) act in cooperation or consultation with any candidate or agent or authorizedcommittee of a candidate who benefits from a disbursement made in opposition to a candidate listed and (thecommittee/ independent disbursement committee does not) (I do not) act in concert with, or at the request orsuggestion of, any candidate or agent or authorized committee of a candidate who benefits from a disbursementmade in opposition to a candidate listed.

, . Is Permanent

Committee for Justice & Fairness - Wisconsin(Full Name of individual, treasurer or agent)

2. OATH

Happ, Susan V. 633 North Dewey Avenue Jefferson, WI 53549 Democratic

Name of Candidate Address Party Pro Con

Full Name: Street, City, State and Zip:

Telephone No: Email:

GAB ID#:

1100074

lora@hppolitics.com

Committee for Justice & Fairness -Wisconsin

PO Box 3526 Washington, DC 20027

(423) 838-8989

THIS FORM MUST BE NOTARIZED AND MAILED

8/11/2019 CJF-Oath of Indepdent Disbursements

2/2

Report Generated On: 09/19/2014GAB-6 (Rev. 04/14)