FEC Form 1 for BLUE DOG POLITICAL ACTION COMMITTEEForm 1 for BLUE DOG POLITICAL ACTION COMMITTEE

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-714889

1. BLUE DOG POLITICAL ACTION COMMITTEE

6849 Old Dominion Drive
Suite 222
McLean, VA 22101
Email: noemailaddress

2. Date: 02/17/2011

3. FEC Committee ID #: C00305318

This committee supports/opposes more than one Federal candidate and is NOT a separate segregated fund or a party committee.

Affiliated Committees/Organizations

NONE
, ____

Custodian of Records:

Leslie J. Kerman
6849 Old Dominion Drive
Suite 222
McLean, VA 22101
Title: Assistant Treasurer
Phone # (571) 633-9741

Treasurer:

JIM COSTA
c/o 6849 Old Dominion Drive
Suite 222
McLean, Virginia 22101
Title: Treasurer
Phone # (571) 633-9741

Designated Agent(s):

Leslie J. Kerman
6849 Old Dominion Drive
Suite 222
McLean, Virginia 22101
Title: Assistant Treasurer
Phone # (571) 633-9741

Banks or Depositories

CITIBANK F.S.B.
1001 Pennsylvania Avenue, NW
Washington, DC 20004

Chain Bridge Bank, N.A.
1445-A Laughlin Avenue
McLean, Virginia 22101

PNC Bank
6805 Old Dominion Drive
McLean, Virginia 22101

Signed: Leslie J. Kerman
Date Signed: 02/17/2011

(End FEC FORM 1)

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