FEC Form 1 for Continuing A Majority Party Action Committee (CAMPAC)Form 1 for Continuing A Majority Party Action Committee (CAMPAC)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-495429

1. Continuing A Majority Party Action Committee (CAMPAC)

5915 Eastman Avenue Suite 100
Midland, MI 48640
Email: jackie.medema@ahpplc.com

NOTE: Email address is different than previously reported

2. Date: 09/28/2010

3. FEC Committee ID #: C00350462

This 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

Candidate ID# H0MI10071
DAVID LEE CAMP
5905 Wimbledon Court
Midland, Michigan 48642
Affiliated Relationship Code: Leadership PAC Sponsor

TAKE BACK THE HOUSE 2010
25 E MAIN STREET
RICHMOND, Virginia 23219
Affiliated Relationship Code: Joint Fundraising Representative

Custodian of Records:

Jacqueline M. Medema
5915 Eastman Ave. Suite 100
Midland, MI 48640
Title: Treasurer
Phone # (989) 835-7721

Treasurer:

Jacqueline M. Medema
5915 Eastman Ave. Suite 100
Midland, Michigan 48640
Title: Treasurer
Phone # (989) 835-7721

Designated Agent(s):

Banks or Depositories

CHEMICAL BANK & TRUST
333 E. MAIN STREET
MIDLAND, Michigan 48640

SUNTRUST BANK
11501 WEST BROAD STREET
RICHMOND, Virginia 23219

Signed: Jacqueline M. Medema
Date Signed: 09/28/2010

(End FEC FORM 1)

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