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Campaign Finance Complaint Form Michigan Department of State ‘This complaint form may be used to file a complaint alleging that someone violated the Michiga paign Fi Act (the MCFA, 1976 PA 388, as amended; MCL 169.201 e¢ seq.). All information on the form must be provided along with an original signature and evidence. Please print or type all information Lallege that the MCFA was violated as follows: Section 1. Complainant Taran Taine pho Taner Lonnie Scott a 7) 999-3646 Mulise S915 S Washington Sq, Suite 135 oy 5 Sie Tp Lansing MI 48933 Section 2. Alleged Violator *=° Clean Ml Committee Mallee ire 3602 Waverly Hills Road Cay Tae Tip Lansing MI 48917 Section 3. Alleged Violations (Use additional sheet if more space is needed.) ‘Section() of the MCTA violated: 169.226 Explain how those sections were violated Aseries of ads, a total of seven, were released by MIPAC to promote an announcement by Brian Calley on May 30, 2017. The announcement was the ballot proposal for Clean MI Committee. In the most recent report from the Clean MI Committee, they failed to report the ads in their Petition Proposal Statement on June 19, 2017 as an in-kind contribution. [idence that supports those allegations (tach copis of pertinent documents sn other infrmation} | have attached to this document a series of links to the ads on Facebook that show May 30, 2017 as the announcement date, as well as the actual announcement by Brian Calley. Screenshots of the end of each ad are attached to show the the date promoted for the announcement. Section 4. Certification (Required) I certify that to the best of my knowledge, information, and belief, formed after a reasonable inquiry under the circumstances, each factual contention of this complaint is supported by evidence. LA: oy /, x Yr da v/2e/r7 Sig of Conant Dae Section 5. Certification without Evidence (Supplemental to Section 4) {i the MCA (MCL 169.215) requires that the signed certification found in section 4 of this form be included in every complaint. However, if, after a reasonable inquiry under the circumstances, you are unable to certify that certain factual contentions are supported by evidence, you may also make the following certification: I certify that to the best of my knowledge, information, or belief, there are grounds to conclude that the following specifically identified factual contentions are likely to be supported by evidence after a reasonable opportunity for further inquiry. Those specific contentions are: aes of Complaint Date —ssSSSSssSs Section 15(8) of the MCFA provides that a person who files a complaint with a false certification i responsible for a civil violation of the MCFA. The person may be required to pay a civil fine of up to $1,000.00 and some or all of the expenses incurred by the Michigan Department of State and the alleged violator as a direct result of the filing of the complaint. NN es Mail or deliver the completed complaint form with an original signature and evidence to the following address: Michigan Department of State Bureau of Elections Richard H. Austin Building ~ Ist Floor 430 West Allegan Street Lansing, Michigan 48918 Revised: O16

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