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Official Ballot S16 Nonpartisan Office and Referendum April 6, 2021 Notice to Voters: If you are voting on Election Day, your ballot must be initialed by two (2) election inspectors. If you are voting absentee, your ballot must be initialed by the municipal clerk or deputy clerk. Your ballot may not be counted without initials. (See right column of ballot for initials.) SAMPLEGeneral Instructions School District School District of Janesville Official Ballot School Board Member Vote for not more than 3 Nonpartisan Office Elizabeth Paull and Referendum John E. Hanewall Jessica Davis April 6, 2021 Greg Ardrey for Cathy Burt If you make a mistake on your ballot or Curt Parish Town of Harmony have a question, ask an election write-in inspector for help. (Absentee voters: Contact your municipal clerk.) write-in write-in To vote for a name on the ballot, fill in Janesville School the oval next to the name like this: Referendum District To vote for a name that is not on the ballot, write the name on the line To vote in favor of a question, fill in marked "write-in" and fill in the oval next the oval next to ''Yes,'' like this: to the name like this: To vote against a question, fill in State Superintendent of the oval next to ''No,'' like this: Public Instruction State Superintendent Rock County Vote for 1 Question: Should the State Jill Underly of Wisconsin accept Ballot issued by Deborah Kerr Affordable Care Act Federal __________________________________ write-in Medicaid funds earmarked to expand health insurance __________________________________ Judicial coverage to 176,000 Initials of election inspectors additional Wisconsin Rock County residents resulting in the Absentee ballot issued by Circuit Court Judge Branch 5 state saving $324.5 million? _________________________________ Vote for 1 Initials of Municipal Clerk or Deputy Clerk Mike Haakenson _______________ _______________ write-in If issued by SVDs, both SVDs must initial. Yes Certification of Voter Assistance Municipal No I certify that I marked or read aloud this ballot at the request and direction of a Town Board Chairperson voter who is authorized under Wis. Stat. Vote for 1 §6.82 to receive assistance. Jeff Klenz _________________________________ write-in Signature of assistor Town Board Supervisor Vote for not more than 2 For Official Use Only Jerry Larson Inspectors: Identify ballots required to Matt McNall be remade: write-in write-in ☐ Overvoted Town Clerk ☐ Damaged Vote for 1 Tim Tollefson ☐ Other write-in If this is the Original If this is the Duplicate Ballot, write serial Ballot, write serial number here: number here: ____________ ____________ ____________ ____________ Initials of inspectors who remade ballot Continue voting at top of next column..

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