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FEC FORM 1
1. NAME OF COMMITTEE (in full) ;f"|

STATEMENT OF ORGANIZATION
(Check if name is changed) Example: If typing, type over the lines.

RECEIV f^T:
2 1 M Y 22 A 1= 30 02 A M 1
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I I I I I I I ADDRESS (number and street) (Check if address is changed)

I I I I I I I I I I I I ' I i I i I I i I i I l

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I I I I I I
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' I I I CiTY COMiy/IITTEE'S E-MAIL ADDRESS (Please provide only one e-mail address) (Check if address v' is changed)
J I i L

STATE

ZiP CODE

COMMITTEE'S WEB PAGE ADDRESS (URL) (Check if addressis changed) I I I I I I I l l l i I'I I I I -j I I I i I I i i

2.

DATE

3.

F E C IDENTiFICATiON NUMBER

4.

IS THIS STATEMENT

Mi

NEW (N)

OR

AMENDED (A)

/ certify that I have examined this Statement and to the best of my knowledge and belief it is true, correct and complete.

Type or Print Name of Treasurer

Signature of Treasurer

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NOTE: Submission of false, erroneous, or incomplete information may subject the person signing this Statement to'the penalties of 2 U.S.C. 437g. ANV CHANGE IN INFORMATION SHOULD BE REPORTED WITHIN 10 DAYS.
For further information contact: FediBral Election Commission Toll Free 800-424-9530 Local 202-694-1100

Office Use. Only'

FEC FORM 1
(Revised 02/2009)