Fec Form 1 - Statement Of Organization

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01/31/2014 17 : 53
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STATEMENT OF
FEC
ORGANIZATION
FORM 1
Office Use Only
1.
NAME OF
Example: If typing, type
(Check if name
12FE4M5
COMMITTEE (in full)
is changed)
over the lines.
Suzanne Patrick for Congress
PO Box 3095
ADDRESS
(number and street)
(Check if address
is changed)
Virginia Beach
23454
VA
CITY
STATE
ZIP CODE
COMMITTEE'S E-MAIL ADDRESS
(Check if address
is changed)
Optional Second E-Mail Address
COMMITTEE'S WEB PAGE ADDRESS (URL)
(Check if address
is changed)
M
M
/
D
D
/
Y
Y
Y
Y
2.
DATE
01
31
2014
C
FEC IDENTIFICATION NUMBER
C00548685
3.
OR
4.
IS THIS STATEMENT
NEW (N)
AMENDED (A)
I 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
Jennifer May
M
M
/
D
D
/
Y
Y
Y
Y
Jennifer May
Signature of Treasurer
Date
01
31
2014
[Electronically Filed]
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
For further information contact:
FEC FORM 1
Federal Election Commission
Use
(Revised 06/2012)
Toll Free 800-424-9530
Only
Local 202-694-1100

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