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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-902854

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1. Democratic Club of the Conejo Valley

    P.O. Box 4421
    Thousand Oaks, CA 913591421
    Email: jc.simmons@verizon.net

    NOTE: Email address is different than previously reported

2. Date: 01/28/2014

3. FEC Committee ID #: C00464198

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:

J.C. Simmons
136 Heather Ridge
Newbury Park, CA 91320
Title: Custodian of Records
Phone # (805) 479-7926

Treasurer:

J.C. Simmons
136 Heather Ridge
Newbury Park, California 91320
Title: Treasurer
Phone # (805) 479-7926

Designated Agent(s):

Gary Crummitt
525 E. Seaside Way, #101-C
Long Beach, California 90802
Title: Assistant Treasurer
Phone # (562) 983-0815

Banks or Depositories

Wells Fargo Bank
5000 E. Santa Rosa Rd.
Camarillo, California 93012

Signed: Gary Crummitt, Assistant Treasurer
Date Signed: 01/28/2013

FORM TEXT

(End FEC FORM 1)

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