CampaignFinanceDisclosureStatement

SDCL 12-27
ThefollowingFILEthisformwiththeSecretaryofState'sOffice:

ThefollowingDO NOTFILEthisformwiththeSecretaryofState'soffice
(filethisforminitheofficewherethenominatingpetitionorballotquestion
petitionwasfiled):

StatewidePoliticalActionCommittees(PACs)
StatewidePoliticalParties
CountyPoliticalParties
StatewideBallotQuestionCommittees
LegislativeCommittees
StatewideCandidateCommittees

FullNameofCommittee:

County
Candidates,BallotQuestionCommitteesandPolitical
ActionCommittees
Municipal
Candidates,BallotQuestionCommitteesandPolitical
ActionCommittees
SchoolCandidates
Candidates,BallotQuestionCommitteesandPolitical
ActionCommittees

BootzforHouseComittee

IfyouareaCandidate,listnameasitappearsonyournominatingpetitionandwhatofficeyouareseeking.
CandidateName:

NicoleBootz

OfficeSought:

SDHouseofRepresentatives

TypeofCommittee:

LegislativeCommittee

StreetAddress:

817SouthLawsonSt.,Aberdeen,SD57401

PostalAddress:

817SouthLawsonSt.,Aberdeen,SD57401

TreasurerDaytimePhoneNumber: (605)377-4184
TreasurerEmailAddress:

TreasurerEveningPhoneNumber: (605)377-4184

nikki.bootz@yahoo.com

IfyouareaBallotQuestionCommittee,indicatewhichmeasurethecommitteewasinvolvedwithduringthereportingperiodandwhetherthe
measurewassupportedoropposed.

Opposing?

Supporting?

BallotMeasureNumber(ifhasbeenassigned):

TypeofCampaignStatement (youmustselectone):

X
Pre-Primary

Post-Primary
(non-winner)

Pre-General

Year-End

TerminationofCommittee

Youmayalsoselectoneofthereportsbelowincombinationwithareportabove:

Amendment

TerminationofCommittee

Thefollowingverificationmustbesigned by the Treasurerbeforesubmittingthereport(SDCL 12-27-24 (29))

I

NicoleBootz

,certifythatIhaveexaminedthisreportandtothebestofmyknowledge

andbeliefitistrue,correctandcomplete.Ialsounderstandthatfailuretotimelyfileanystatement,amendment,orcorrectrequiredsubjectsthe
Treasurerresponsibleforfilingtoanadministrativepenaltyoftendollars(countypoliticalpartiesonly)orfiftydollarsperdayforeachdaythatthe
statementremainsdelinquent(SDCL 12-27-29.1).

Date:

Oct28201612:51PM

documentsubmittedelectronicallyby
SignatureofTreasurer

NicoleBootz

INCOME
DirectContributionsfromIndividuals
UnitemizedDirectContributionsfromIndividuals
Sumallcontributionsof$100.00orlessfromindividualsandenterthistotal.

Amount
$

TOTALofallUnitemizedDirectContributionsfromIndividuals:

$0.00

ItemizedDirectContributionsfromIndividuals
Enterallitemizedcontributionsof$100.01ormorefromeachindividualbelow(SDCL 12-27-24 (14)):
Ifyoureceivedacontributionfromanindividualinthecalendaryearthatwillputthemoverthe$100.01contributionlimittheyneedtobelistedinthis
section.
Contributor name

Residence Address (PO Box not accepted)

City and State

TOTALofallItemizedDirectContributionsfromIndividuals:

Amount
$

$0.00

$0.00

DirectContributionsfromOrganizations
Only PAC's and Ballot Question Committees* may receive direct contributions from organizations.Anorganizationisdefinedasany
businesscorporation,limitedliabilitycompany,nonprofitcorporation,limitedliabilitypartnership,lmitedpartership,partnership,cooperative,trust
exceptatrustaccountrepresentingorcontainingonlyacontributor'spersonalfund,businesstrusts,association,club,laborunion,collective
bargainingorganization,local,state,ornationialorganizationtowhichlabororganizationpaysmembershiporpercapitafees,baseduponits
affiliationandmembership,tradeorprofessionalassociationthatreceivesitsfundsfrommembershipduesorservicefees,whetherorganized
insideoroutsidethestate,anyentityorganizedinacorporateformunderfederallaworthelawsofthisstate,oranygroupofpersonsactingin
concertwhichisnotdefinedasapoliticalcommitteeorpoliticalparty.SDCL 12-27-18
*ifyouareaballotquestioncommitteewhichreceivedacontributionfromanorganization,youmustattachtothisreport,theBallot Question
Statementyoureceivedfromtheorganization.Todoso,faxto605-773-6580,oremailtocfr@state.sd.us.
Organization name

Street Address

City and State

Amount

TOTALofallItemizedDirectContributionsfromOrganizations:

$0.00

$0.00

DirectContributionsfromPoliticalParties
ApoliticalpartyisdefinedbySDCL 1-27-1 (20).AllcontributionsfromPoliticalPartiesmustbeenteredasaseparateitem(itemized),listingthe
requiredinformationbelow.
Political Party name

Street Address

City and State

TOTALofallItemizedDirectContributionsfromPoliticalParties

Amount
$

$0.00

$0.00

DirectContributionsfromIn-StatePoliticalActionCommittees
Apoliticalactioncommittee(PAC)isdefinedbySDCL 1-27-1(18).
In-State PAC name

Street Address

City and State

TOTALofallItemizedDirectContributionsfromIn-StatePoliticalActionCommittees:

Amount
$

$0.00

$0.00

DirectContributionsfromOut-of-StatePoliticalAction
Committees
AllcontributionsmustbeitemizedseparatelyandincludethePACnameandwebsiteaddressofthefilingofficewherethePACregularlyfilestheir
campaignfinancereport(s).

Out-of-State or Federal PAC Name

Filing Website Address

Amount
$

$0.00

TOTALofallItemizedDirectcontributionsfromOut-of-StateorFederalPACs: $

$0.00

DirectContributionsfromCandidateCommittees
AcandidatecommitteeisdefinedbySDCL 1-27-1(3).
Candidate Committee name

Street Address

Amount

City and State

TOTALofallItemizedDirectContributionsfromCandidateCommittees:

$0.00

$0.00

OtherIncome
Thissectionreportsallincomereceivedfromanyrefunds,rebates,interestearned,saleofproperty,orotherincomewhichisnotadirect
contribution,receivedduringthisreportingperiod.Any initial source of inome from a loan that is received should be listed here.
Source of Income

Description

Amount
$

$0.00

TOTALofallOtherIncome: $

$0.00

In-KindContributions
Anin-kindcontributionisdefinedasagoodorserviceprovidedatnochargeorforlessthatitsfairmarketvalue.Thetermdoesnotincludethe
valueofservicesprovidedbyapersonasavolunterrfororonbehalfofanycandidate,politicalcommittee,orpoliticalparty,includingthefreeor
discounteduseofanyperson'sresidenceoroffice.
Residence Address

Name

City and State

Description

Amount
$

$0.00

TOTALofallestimatedIn-KindContributions $

$0.00

EstablishingandAdministeringCommittee/SolicitationCosts
Listacategoricaldescriptionandtheestimatedvalueoffundsordonationsbyanorganizationtoitsownpoliticalcommitteeforestablishingand
administeringthepoliticalcommitteeorsolicitationcostsofthepoliticalcommittee.
(Thissectionisrarelyused).SDCL 1-27-24 (19)
Categorical Description

Source of Income

Amount
$

$0.00

TOTALofallEstablishingandAdministeringCommittee/SolicitationCosts: $

$0.00

EXPENDITURES
Expenditures
Thissectionreportsexpensesthatthecommitteehasincurred.Categorieshavebeenprovidedforreportingcommonexpenses.Allotherexpenses
shouldbelisted.
Categorical Description

Description (if category is "Other")

Amount
$

$0.00

TOTALofallExpenditures: $

$0.00

ContributionsMadetoCandidatesandCommittees
Thissectionreportsallcontributionsthatthiscommitteehasmadetoanothercandidateorcommittee.
Amount

Name of Candidate or Committee

$

$0.00

TOTALofallContributionstoOtherCandidatesandCommittees: $

$0.00

ExpendituresIncurredbutnotyetPaid
(priorreportslistedtheseasOutstandingDebtsandObligations)
Thissectionreportsallexpendituresincurredbythiscommitteebuthavenotbeenpaidduringthisreportingperiod(i.e.consultingservicesthathave
beencontractedbutnotyetbilled).Ifaservicehasbeencontractedbutnotyetbilled,estimatetheamountoftheobligation.
Owed to

Amount
$

$0.00

TOTALamountofExpendituresIncurredbutnotyetPaid: $

$0.00

LoansOwedTOCommittee
Thissectionreportsallloansthatthiscommitteehasmadetoothers(i.e.loantoanothercandidatecommittee).Pleaselistthename,address,cityand
stateforeachloanandtheamountofloangivenduringthereportingperiod.Alsolistthebalanceofeachloanattheendofthereportingperiod.

Recipient Name

Address

Balance of loan
committee owes
at the end of the
reporting period

Amount of loan given

during reporting period

City and State

$
TOTALLoansOwedTOthisCommittee: $

$0.00 $

$0.00

$0.00

$0.00

LoansOwedBYCommittee
Thissectionreportsallloansthathavebeengiventothiscommittee(i.e.personalloantocommittee).Pleaselistthename,address,cityandstateof
thelenderandtheterms,interestrateandrepaymentschedule.Alsolistthebalanceofeachloanattheendofthereportingperiod.Ifpartofaloan
hasbeenrepaid,pleasealsolistthatexpenseintheLoanRepaymentcategoryofOperationalExpenditures(seeabove).Iftheloanisaninitial
sourceofincome,pleasealsolisttheamountoftheloanintheLoanIncomecategoryofOtherIncome(seeabove).

Lender Name

Address

City and State

Balance of loan
committee owes
at the end of the
reporting period

Terms, Interest Rate and

Repayment Schedule

$0.00

TOTALLoansOwedBYthisCommittee: $

$0.00

SUMMARYOFINCOMEANDEXPENDITURES
Thisisthesummaryoftransactionsconductedfuringthereportingperiod.
Balanceofcashandcashequivalentsonhand,ifany,atthebeginningofthereportingperiod.

$0.00

Thebeginningbalanceshouldbezerofornewcommitteesortheendingbalanceofthepreviousreportfiledforexistingcommittees.
INCOME

EXPENSES

INCOMETOTALS
UnitemizedContributions

$0.00

ItemizedContributions

$0.00

ContributionsfromOrganizations

$0.00

ContributionsfromPoliticalParties

$0.00

ContributionsfromIn-StatePoliticalActionCommittees

$0.00

ContributionsfromOut-of-StateorFederalPoliticalActionCommittees

$0.00

ContributionsfromCandidateCommittees

$0.00

OtherIncome

$0.00

$0.00

TOTALofcashIncome
EXPENSETOTALS
OperationalExpenditures

$0.00

ContributionstoCandidatesandCommittees

$0.00

$0.00

TOTALofcashExpenses

Amountofcashonhandattheendofthereportingperiod: $
$0.00
TheendingbalancecannotbenegativeandifthisisaTermination Report,theendingbalancemustbezeroandtherecannotbeanyoutstanding
debts,obligationsorloans.

SUMMARYOFTRANSACTIONSNOTINCLUDEDABOVE
Thisisthesummaryofallnon-cashtransactionsconductedruingthereportingperiod.Theseamountsdo notcalculateintotheAmountofcashon
handattheendofthereportingperiodabove.

In-KindContributions

$0.00

EstablishingandAdministeringCommittee/SolicitationCosts

$0.00

ExpensesIncurredbutnotyetPaid

$0.00

LoansOwedTOthisCommittee

$0.00

LoansOwedBYthisCommittee

$0.00

Date/TimeReceived: Oct28201612:51PM
Date/TimeFiled:

Oct28201612:51PM