FEC Form 1 for GRASS ROOTS NORTH CAROLINA/FORUM FOR FIREARMS EDUC POL VICTORY FUNDForm 1 for GRASS ROOTS NORTH CAROLINA/FORUM FOR FIREARMS EDUC POL VICTORY FUND

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-747051

1. GRASS ROOTS NORTH CAROLINA/FORUM FOR FIREARMS EDUC POL VICTORY FUND

5200 Rocky River Rd.
Charlotte, NC 28215
Email: grncpvf@att.net

NOTE: Email address is different than previously reported

2. Date: 10/07/2011

3. FEC Committee ID #: C00354605

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:

Grant Gardner
5200 Rocky River Rd.
Charlotte, NC 28215
Title: Treasurer
Phone # (704) 301-6602

Treasurer:

Grant Gardner
5200 Rocky River Rd.
Charlotte, North Carolina 28215
Title: Treasurer
Phone # (704) 301-6602

Designated Agent(s):

Paul Valone
PO Box 10665
Raleigh, North Carolina 27605
Title: Asisstant Treasurer

Banks or Depositories

Wachovia Bank, NA
PO Box 563966
Charlotte, North Carolina 28262

Signed: Grant Gardner
Date Signed: 10/07/2011

(End FEC FORM 1)

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