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Candidate Re It
Commencement of Candidacy
8401 Greenway Blvd., Ste 210 Middleton, WI (mm/ddlyy):
53562
Did you or your spouse have earned income (e.g., salaries or fees) or non-
investment income of more than $200 from any reportable source in the Did you hold any reportable positions during the reporting period?
reporting period? If Yes, Complete and Attach PART VIII.
If Yes, Complete and Attach PART II.
Did you, your spouse, or dependent child hold any reportable
Did you have any reportable agreement or arrangement with an outside
asset worth more than $1,000 at the end of the period or receive unearned
entity on the filing date? .
or investment income of more than $200 in the reporting period?
If Yes, Complete and Attach PART IX,
If Yes, Complete and Attach PART iliA and/or illS-
Did you, your spouse, or dependent child have any reportable liability Did you receive compensation of more than $5,000 from a single source,
(more than $10,000) during the reporting period? in the two prior years?
If Yes, Complete and Attach PART VII. If Yes, Complete and Attach PART X,
Fife this report and any amendments with the Secretary of the Senate, Office of Public Records, Room 232, Hart S nate Office
Building, U.S. Senate, Washington, DC 20510. $200 Penalty for filing more than 30 days after due date.
This Financial Disclosure Statement is required by the Ethics in Government Act of 1978, as amended. The statement will be FOR OFFICIAl. USE ONLY
Do Not Write Below this Line
made available by the Office of the Secretary of the Senate to any requesting person upon written application and will be
reviewed by the Select Committee on Ethics. Any individual who knowingly and willfully falsifies, or who knowingly and willfully
Certification
I
S' . fR .. .
fails to file this fe ort ma be sub'ect to civil and criminal sanctions. See 5 U.S.C. a .6,104, and 18 U.S.C. 1001.
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,
Date Month,Da • Year
p!p/*,
I CERTIFY that the statements I
have made on this form and all
attached schedules are true.
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10
11
12
13
Reporting Individual's Name
Terrence R. Wall
'::
3 M&I Bank (checking aeet)
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EXEMPTION TEST (soe instruc/ions before marking bOx): If yOu omitted any asset because it meets the three-part test for exemption described in the instructions, please check box to the right.
••• This category applies only II the asset is/was held independently by the spouse or dependent child. If the asset is/was either held by the filer or jointly held, use the other categories of value, as appropriate.
D
Reporting Individual's Name Page Number
Terrence R. Wall PART iliA. PUBLICLY TRADED ASSETS AND UNEARNED INCOME SOURCES 3
BLOCK A BLOCKB BLOCKC
Identity of Publicly Traded Assets Valuation of Assets Type and Amount of Income
And Unearned Income Sources At the close of reporting penod. If 'None (or less than $201 r
is Checked. no other entry is needed in Block C for that item. This
If None, or less than $1.001. includes income received or aCCllJed to the benefit of the individual.
Report the complete name of each publicly Check the first column.
traded asset held by you, your spouse, or Type of Income Amount of Income
your dependent child. (See p.3,
CONTENTS OF REPORTS Part B of
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ReportingIndividual'sName Page Number
Terrence R. Wall PART iliA. PUBLICLY TRADED ASSETS AND UNEARNED INCOME SOURCES 4
BLOCK A BLOCKS BLOCKC
Identity of Publicly Traded Assets Valuation of Assets Type and Amount of Income
And Unearned Income Sources
At the close of reporting period. If ·None (or less than $201)" is Checked, no other entry is needed in Block C for that item. This
Report the complete name of each publicly If None. or less than $1,001, includes income received or accrued to the benefit of the individual.
Check the first column.
traded asset held by you, your spouse, or Type of Income Amount of Income
your dependent child, (Seep.3, ,.
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EXEMPTIONTEST (see instructions before marking box); If you omitted any asset because it meets the three-parttest for exemptiondescribed in the instructions,please check box to the right.
••• Thiscategory applies only if the asset is/washeld independentlyby the spouseor dependentchild. If the asset Istwaseither held by the filer or jointly held.use the other categories of value. as appropriate. D
Reporting Individual's Name
Terrence R. Wall
. "
EXEMPTION TEST (see instructions before marking box): If you omitted any asset because it meets the three-part test for exemption described in the instructions, please check box to the right.
••• This category applies only if the asset islwas held independently by the spouse or dependent child. If the asset is/Was either held by the filer or jointly held, use the other categories of value. as appropriate.
D
ReportingIndividual'sName Page Numbef
Terrence R. Wall PART iliA. PUBLICLY TRADED ASSETS AND UNEARNED INCOME SOURCES 6
BLOCK A BLOCKS BLOCKC
Identity of Publicly Traded Assets Valuation of Assets Type and Amount of Income
And Unearned Income Sources
At the dose of reporting period. If "None (or less than $201 r is Checked, no other entry is needed in Block C for that item. This
Report the complete name of each publicly If None, or less than $1.001, indudes income received or accrued to the benefit of the individual.
Check the first column.
traded asset held by you, your spouse, or Type of Income Amount of Income
your dependent child, (See p.3, ~
CONTENTS OF REPORTS Part B of '.
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EXEMPTIONTEST (see instructions before marking box): If you omitted any asset because it meets the three-part lest for exemption described in the instructions,please check box to the right.
••• This categoryapplies only if the asset is/was held independently by the spouse or dependent child. If the asset is/Waseither held by the filer or jointly held, use the other categories of value, as appropriate. D
ReportingIndividual'sName PageNumber
Terrence R. Wall PART iliA. PUBLlCL Y TRADED ASSETS AND UNEARNED INCOME SOURCES 7
BLOCK A BLOCKS BLOCKC
Identity of Publicly Traded Assets Valuation of Assets Type and Amount of Income
And Unearned Income Sources If "None (or less than $201)" is Checked, no other entry is needed in Block C for that item. This
At the close of reporting period.
If None, or less than $1,001. includes in'?Omereceived or accrued to the benefit of the individual.
Report the complete name of each publicly
Check the first column.
traded asset held by you, your spouse, or Type of Income Amount of Income
your dependent (See p.3,
child,
CONTENTS OF REPORTS Part B of
Instructions) for production of income or
investment which:
(1) had a value exceeding $1,000 at the
Actual
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EXEMPTION TEST (see instructions before marking box): If you omitted any asset because it meets the three·part test for exemption described in the instructions, please check box to the right.
••• This category applies only if the asset islwas held independently by the spouse or dependent child. If the asset islwas either held by the filer or jointly held, use the other categories of value, as appropriate. D
ReportingIndividual'sName PageN"_
Terrence R. Wall PART iliA, PUBLlCL Y TRADED ASSETS AND UNEARNED INCOME SOURCES 8
BLOCK A BLOCKS BLOCKC
Identity of Publicly Traded Assets Valuation of Assets Type and Amount of Income
And Unearned Income Sources At the dose of reporting period, If 'None (or less than $201)" is Checked, no other entry is needed in Block C for that item. This
If None, or less than $1,001, Indudes income received or accrued to the benefit of the individual,
Report the complete name of each publicly
.~~.
Check the first column.
traded asset held by you, your spouse, or Type of Income Amount of Income
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child, '''':. .. '.1'" ., c- "
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EXEMPTION TEST (see instructions before marking box): If you omitted any asset because it meets the three-part test for exemption described in the instructions, please check box to the right.
•• This category applies only If the asset is/was held independently by the spouse ordependenl child. If the asset islwas either held by the filer or jointly held, use the other categories of value, as appropriate, 0
ReportingIndividual'sName Page Number
Terrence R. Wall PART iliA. PUBLlCL Y TRADED ASSETS AND UNEARNED INCOME SOURCES 9
BLOCK A BLOCKS BLOCKC
Identity of Publicly Traded Assets Valuation of Assets Type and Amount of Income
And Unearned Income Sources'
At the dose of reporting period. r
If "None {or less than $201 is Checked, no other entry is needed in Block C for that item. This
If None, or less than $1,001. includes income received or accrued to the benefit of the indIvidual.
Report the complete name of each publicly
Check the first column.
traded asset held by you, your spouse, or Type of Income Amount of Income
your dependent (See p.3.
child, ,
~
,. -, ;- .
CONTENTS OF REPORTS Part B of ., ' '
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••• This category applies only if the asset is/was held independently by the spouse or dependent child. If the asset is/Waseither held by the filer or jointly held, use the other categories of value, as'appropriate . D
ReportirlgIrldividual'sName Pag"Number
Terrence R. Wall PART IIIB. NON·PUBLlCL Y TRADED ASSETS AND UNEARNED INCOME SOURCES 10
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XEMPTION TEST (see instructions before marking box): If you omitted any asset because it meets the three-part test for exemption described in the instructions. please check box to the right.
• This category applies only if the asset is/was held independently by the spouse or dependent child. ,Ifthe a'sse! is/was either held by the filer or jointly held. use the other categories of value, as appropriate, D
ReportingIndividual'sName PageNumbef
Terrence R.Wall
PART 1118. NON-PU8L1CL Y TRADED ASSETS AND UNEARNED INCOME SOURCES 11
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••• This category applies only if the asset is/was held independently by the spouse or dependent child. If the asset islwas either held by the filer or jointly held, use the other categories of value. as appropriate, D
Reporting Individual's Name Page Number
Terrence R.Wall PART 1118. NON-PUBUCL Y TRADED ASSETS AND UNEARNED INCOME SOURCES 12 I
I
BLOCK A BLOCKB BLOCKC
Identity of Non-Publicly Traded Valuation of Assets Type and Amount of Income
Assets and Unearned Income Sources At the dose of reporting period. If ·None (or less than $201)" is Checked, no other entry is needed in Block C for that item. This
If None, or less than $1,001, includes income received or accrued to the benefit of the individual.
Report the name, address (city, state and Check the first column.
description) of each interest held by you, Type of Income Amount of Income I
your spouse, or your dependent child (See
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•• This category applies only jf the asset is/was held independenlly
any asset because it meels the three-part test for e;(errlption described in the instructions, please check box to the right
by the spouse or dependent child, If the asset is/was either held by the filer or jointly held, use the other categories of value, as appropriate, D
BLOCK A BLOCKS BLOCKC
Identity of Non-Publicly Traded Valuation of Assets Type and Amount of Income
Assets and Unearned Income Sources At the close of reporting period. If ·None (or less than $201 r
Is Checked, no other entry is needed in Block C for that item. This
If None, or les$ than $1,001, indudes income received or accrued to the benefit of the individual.
Report the name, address (city, state and Check the first column.
description) of each interest held by you,
your spouse, or your dependent child (See
p.3. CONTENTS OF REPORTS Part B of
Instructions) for the production of income
or investment in a non-public trade or
business which: Actual
(1) had a value exceeding $1,000 at the oC!..'", Amount
close of the reporting period; and/or ;;;
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income during the reporting period. ;::
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underlying asset, which is not incidental to
the trade or business. PUblicly traded
assets held by non-public entity may be
listed on Part iliA.
s. JP Computer, Software Design, ~1~(';
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Example: DC. Wash DC
or J Undeveloped land, DubuQue, Iowa ,s"", Example eX.
EXEMPTION TEST (see instructions before marking box); If you omitted any asset because it meets the three-part lest for exemption described in the instructions. please check box to the right.
••• This category applies only if the asset is/was held independently by the spouse or dependent child. If the asset islwas either held by the filer or joinUy held. use the other categories of value. as appropriate. D
Page Number
Reporting Individual's Name
Terrence R. Wall PART 1118. NON-PUBLICLY TRADED ASSETS AND UNEARNED INCOME SOU~CES 14
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EXEMPTION TEST (see ins/ructions before marking box): If you omitted any asset because it meets the three-part test for exemption described in the instructions, please check box to the right.
( •• This category applies only if the asset is/was held independently by the spouse or dependent child. If the asset is/was either held by the filer or jointly held, use the other categories of value, as appropriate, D
Report liabilities over $10,000 owed by you, your spouse, or dependent child (See p.3
0
CONTENTS OF REPORTS Part B of Instructions), to anyone creditor at any time
..
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••• This category applies only if the asset is/was held independently by the spouse or dependent child. If the asset islwas either heid by the filer or jointly heid, use the other categories of value, as appropriate,
D
Reporting Irldividual's Name PageNl)mber
Report any positions held by you during the applicable reporting period whether compensated or not. Positions include, but are not limited to those of an
officer, director, trustee, general partner, proprietor, representative, employee, or consultant of any corporation, firm, partnership, or other business
enterprise or any non-profit organization or educational institution. Both the year and month must be reported for the period of time that the position was
held.
Exclude: Positions with federal government, religious, social, fraternal, or political entities, and those solely of an honorary nature.
From To
Name of Organization Address (City, State) Type of Organization Position Held
(MolYr) (MoNr)
National Assn. of Rock Collectors NY,NY EXAMPLE Non-profit education President 6/90 Present
Example:
Jones & Smith Hometown, USA EXAMPLE Law Firm Partner 7195 11 lOX
3 The Wisconsin Foundation Middleton, WI Public charity Board Member 4108 Present
4 Wall Family Enterprise, Inc. Madison,WI Library& schoolsuppliessales Board Member 10/09 Present
6 T. Wall Properties Arizona, LLC Middleton, WI Manager of AZ Funds, .. President •• 9105 Present
II
7 SmartGrowthMadison Madison,WI Trade/BusinessAssoc BoardMember 1/03 Present
OaneVest Tecl1 Fund & OaneVest Tech Fund Advisors Middleton, WI Angel Investment Advisory Board Member 12/07 Present
8
9 West End Condo Association, Inc. Middleton,WI Condo Owners Association Board Member 12/08 Present
10 WestEndCondoAssociationof Verona, Inc. Middleton, WI Condo Owners Association Board Member 12/08 Present
12
13