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FEC FORM 1
1. NAME OF COMMITTEE (in full) l"l U

STATEMENT OF ORGANIZATION
(Check if name is changed) Example: If typing, type over the lines. j 12FE4M;

RECEIVED

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ADDRESS (number and street) n LJ CO ^ (Check if address is changed)

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STATE

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COMMITTEE'S E-MAIL A D D R E S S

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ZIP C O D E A

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Optional Second E-Mail Address I I I I I I I I I I I I I I I I I I

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COMMITTEE'S W E B PAGE A D D R E S S (URL) (Check if address is changed)

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2.

DATE

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A M E N D E D (A)

3. FEC IDENTIFICATION NUMBER ^

4. IS THIS STATEMENT

NEW (N)

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

Type or Print Name of Treasurer

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Signature of Treasurer

Date W ll io "7] VZ D I ^

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

FEC FORM 1
(Revised 06/2012) |

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5.

FEC

Form 1 (Revised 02/2009)

Page 2

TYPE OF COMMITTEE

Candidate Committee:

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( b )

This committee is a principal campaign committee. (Complete the candidate information below.) This committee is an authorized committee, and is NOT a principal campaign committee. (Complete the candidate information below.) I Office Sought: I I. State House Senate President District
I I I

Name of Candidate Candidate Party Affiliation

(c) Name of Candidate

This committee supports/opposes only one candidate, and is NOT an authorized committee.
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Party Committee:
(*^) IJ ^l^'S committee is a (National, State or subordinate) committee of the (Democratic, Republican, etc.) Party.

Poiiticai Action Committee (PAC):

(e) Q This committee is a separate segregated fund. (Identify connected organization on line 6.) Its connected organization is a: Q Q Corporation Membership Organization Q (f) ri " Q Q Corporation w/o Capital Stock Trade Association PAC. Q Q Labor Organization Cooperative

In addition, this committee is a Lobbyist/Registrant

This committee supports/opposes more than one Federal candidate, and is NOT a separate segregated fund or party committee, (i.e., nonconnected committee) Q Q In addition, this committee is a Lobbyist/Registrant In addition, this committee is a Leadership PAC. PAC.

(Identify sponsor on line 6.)

Joint Fundraising Representative:

(9) (h) This committee collects contributions, pays fundraising expenses and disburses net proceeds for two or more political committees/organizations, at least one of which is an authorized committee of a federal candidate. This committee collects contributions, pays fundraising expenses and disburses net proceeds for two or more political committees/organizations, none of which is an authorized committee of a federal candidate.

Comnnittees Participating jn Joint Fundraiser

FEC I I FEC ID numberiQ ID numberiC

J FEC ID number I FEC ID number

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6.

1
FEC Form 1 (Revised 02/2009) Page 3

Write or Type Committee Name

Name bf Any Connected Organization, Affiliated Committee, Joint Fundraising Representative, or Leadership PAC Sponsor

Mailing Address

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CITY STATE

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L ZIP CODE

Relationship: j l Connected Organization | |Affiliated Committee i | Joint Fundraising Representative r i Leadership PAC Sponsor

7.

Custodian df Records: Identify by name, address (phone number -- optional) and position of the person in possession of committee books and records.

Full Name Mailing Address

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I I I I I I |CI2I2L^L I ! I
ZIP CODE

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STATE

Title or Position

CITY

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8.

Telephone number

Treasurer: List the name and address (phone number ~ optional) of the treasurer of the committee; and the name and address of any designated agent (e.g., assistant treasurer). Full Name of Treasurer Mailing Address ,_ ^ rTigiCiVi ^ ^gi6l^i

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I 1 I I CITY

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STATE Telephone number

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ZIP CODE -1 f I ^ J r H

Title or Position
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FEC Form 1 (Revised 02/2009)

Page 4

Full Name of Designated Agent Mailing Address

I I I I I I I I II
I I I 1 I I I I I I I I I I I I I I I I

I I I 1 I I I I 1 I I I I I I I I
I I I I I I

I I I 1 I r I j r
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CITY Title or Position 0*. I I I I I I I I I l-r

STATE

ZIP CODE

Telephone number

9.

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Banks or Other Depositories: List all banks or other depositories in which the committee deposits funds, holds accounts, rents safety deposit boxes or maintains funds. Name of Bank, Depository, etc.

l i l l Mailing Address

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CITY Name of Bank, Depository, etc.

STATE

ZIP CODE

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1 1 - 1 1 1 1 1 1 1
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I I I I I I

Mailing Address
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I 1L CITY STATE ZIP CODE

RECEIVED
2uiUAH15 A H1 0 ^ 01 FEC MAIL CENTER

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Federal Election Commission ENVELOPE REPLACEMENT PAGE FOR INCOMING DOCUMENTS The FEC added this page to the end ofthis filing to indicate how it was received. Date of Receipt Hand Delivered Postmarked USPS First Class Mail Postmarked (R/C) USPS Registered/Certified Postmarked USPS Priority Mail

Postmarked USPS Priority Mail Express

Postmark Illegible

No Postmark Shipping Date Overnight Delivery Service (Specify): Next Business Day Delivery Date of Receipt Received from House Records & Registration Office Date of Receipt Received from Senate Public Records Office Date of Receipt Received from Electronic Filing Office Date of Receipt or Postmarked Other (Specify):

PREPARER ( 8 / 2 0 1 3 )

DATE PREPARED