MICHIGAN DEPARTMENT OF STATE
BUREAU OF ELECTIONS
LATE FILING FEE WAIVER REQUEST FORM
Committee ID
Full Name of Committee
STATEMENTS REQUESTING LATE FILING FEE REVIEW
The required filing, statement, or report must be filed in order for the late filing fee waiver to be reviewed.
Year Statement was Due
Statement
Date Filed
THE GOOD CAUSE REASON, DESCRIPTION AND ADEQUATE SUPPORTING DOCUMENTATION
Attach a brief description of the incident which caused the late filing along with ALL supporting documentation. Supporting
documentation must include relevant dates that occur on or extend through the filing deadline to substantiate the waiver.
Please check ALL that apply in the sections below.
The persons who these causes relate to are limited to:
"A person required to file." Meaning the:
candidate (Candidate Committee’s only);
treasurer;
designated record keeper; or
a person whose participation is essential to
the preparation of the statement or report.
Please Specify: ___________________
"A member of the immediate family" of a person required to
file. Immediate family means:
a child residing in the individual's household;
a spouse of the individual; or
any individual claimed by that individual or individual's
spouse as a dependent on federal income taxes.
ADEQUATE DOCUMENTATION INCLUDES
Incapacitating physical illness
A doctor's statement noting the name of the patient, the incapacitating
illness and the dates of the illness.
Hospitalization
A copy of the hospital bill or doctor's statement showing the patient's name
and the dates of the hospitalization.
Accident involvement
Medical: a copy of the hospital bill, emergency room services or doctor’s
statement showing the patient’s name, dates and times of medical
attention.
Delay or vehicle disablement: a police report showing the individual's
name, the date and time of the accident and, if applicable, whether or not
the vehicle was disabled.
Death
A copy of the death certificate or an obituary notice.
Incapacitation for medical reasons
Doctor, psychologist, therapist, or chiropractor statement giving the
patient’s name and the nature of the incapacitation with the relevant dates.
ADEQUATE DOCUMENTATION INCLUDES
The loss or unavailability of records due
to a fire, flood, theft or similar reason.
Police, fire or insurance report containing the date of the occurrence and
the extent of the loss or damage.
Difficulties in the transmission of the
filing because of bad weather or strikes
involving transportation.
Relevant weather reports or verification of a transportation systems strike
that directly affects systems necessary for filing the report or statement.
Other unique, unintentional factors
beyond the filer’s control not stemming
from a negligent act or non-action.
Documentation that substantiates the reason the filing was delayed which
includes the name of affected person and any relevant dates. (Please see
the Other Considerations section on the next page).
SIGNATURE
Please provide the signature(s) of the individual(s) required to file the particular statement or report upon which the late
filing fee was or would be assessed.
Signature
Title
Date
Candidate (Candidate Committee’s only)
Treasurer
Clear Form
01/2023
INSTRUCTIONS
S
ection 15
of the Michigan Campaign Finance Act (MCFA) gives the Secretary of State and county clerks throughout the
state the authority to waive the payment of a late filing fee if the request for the waiver is based on "good cause." Please
note: The report or statement must be filed before a waiver can be granted.
REQUESTING A LATE FILING FEE WAIVER
A waiver request must be submitted in writing to the appropriate filing official within 6 months of the original assessment
and must:
1. Indicate the statement(s) for which the late fee(s) were assessed;
2. Indicate the good cause reason(s) for the request (along with a brief description of the incident causing the lat
e
f
iling);
3. Provide adequate documentation which includes relevant dates that occur on or extend through the fili
ng
deadl
ine; and
4. Contain the signature(s) of the individual(s) required to file the particular statement or report upon which the lat
e
f
iling fee was assessed.
S
UBMITTING THE FORM
1. Complete each section of the form.
2. Mail the form, all adequate documentation and a brief description of the incident which caused the late filing to the
appropriate filing official.
B
ureau of Elections:
US Mail: Overnight Delivery or Visit Our Office:
PO Box 20126 430 W. Allegan St, 1st Floor - Richard H. Austin
Lansing, MI 48901-0726 Lansing, MI 48918 -1700
Em
ail: Disclosure@michigan.gov Web: www.michigan.gov/campaignfinance
STATE LEVEL FILERS – DETERMINATION OF LATE FILING FEE WAIVER REQUEST
• Approved: If a request for a waiver is approved by the Bureau of Elections, the committee requesting the waiver
will be informed in writing and the fees will no longer be owed.
• Denied: If a request for a waiver is denied by the Bureau of Elections, the committee requesting the waiver will be
informed in writing of the reason(s) for the denial. The Bureau of Elections will automatically deny any
requests that are not received within 6 months of the original late filing fee assessment.
Committees seeking to appeal the Bureau of Elections decision to deny a wavier request may submit a written
r
equest including all of the information required in the original waiver request to Legal and Regulatory Service
s
A
dministration, Richard H. Austin Building 4
th
Floor, Lansing, Michigan 48918. Appeals cannot be requested for
waiver requests that were automatically denied by the Bureau of Elections for being received more than 6
months after the original late filing fee assessment.
LOC
AL LEVEL FILERS – DETERMINATION OF LATE FILING FEE WAIVER REQUEST
Please contact your local county clerk for information on the review and determination of late filing fee waiver requests.
O
THER CONSIDERATIONS
The following are not acceptable "good cause" reasons to request a waiver(not a complete list):
• not receiving notice of filing requirements
• not being in town
• not picking up mail
• not being aware of law or its requirements
• not being aware of the electronic filing requirements
• not preparing to file electronically in a timely manner
• not knowing where to get forms or software
• not mailing filing until deadline date
• not sending filing to proper filing official
• attempting to file unsuccessfully
Please note that this form is not required to be used in order to be eligible for a good cause waiver of late filing fees.