FEC FORM 1
STATEMENT OF ORGANIZATION
FILING FEC-409997
1. American Success Political Action Committee
1155 21st Street NWSuite 300
Washington, DC 20036
Email: mgkelley@wms-jen.com
2. Date: 03/27/2009
3. FEC Committee ID #: C00336644This committee supports/opposes more than one Federal candidate and is NOT a separate segregated fund or a party committee.
In addition, this committee is a Leadership PAC.
Affiliated Committees/Organizations
David Dreier
233 Cannon HOB
Washington, DC 20515
Affiliated Relationship Code: Leadership PAC Sponsor
Custodian of Records:
Meredith Kelley
1155 21st ST, NW
Suite 300
Washington, DC 20036
Phone # (202) 659-8201
Treasurer:
Walt Mix
1155 21st Street, NW
Suite 300
Washington, DC 20036
Designated Agent(s):
Banks or Depositories
Chain Bridge Bank
1445-A Laughlin Avenue
McLean, Virginia 22101
Signed: Walt Mix
Date Signed: 03/27/2009
(End FEC FORM 1)
Date Signed: 03/27/2009