FEC Form 1 for GRAND CANYON STATE CAUCUSForm 1 for GRAND CANYON STATE CAUCUS

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-475931

1. GRAND CANYON STATE CAUCUS

PMB 326
8711 E. Pinnacle Peak Rd
Scottsdale, AZ 85255
Email: grand.canyon.state.caucus@gmail.com

2. Date: 05/01/2010

3. FEC Committee ID #: C00473249

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:

Patricia Nast Beran
8522 E Via del Sol
Scottsdale, AZ 85255
Title: President
Phone # (480) 229-5668

Treasurer:

Patricia Nast Beran
8522 E Via del Sol
Scottsdale, Arizona 85255
Title: President
Phone # (480) 229-5668

Designated Agent(s):

Kenneth W Seidberg
1552 W. Augusta
Phoenix, Arizona 85021
Title: Vice President
Phone # (602) 248-8117

Allen Silberman
6302 E. Vista Dr
Paradise Valley, Arizona 85253
Title: Treasurer
Phone # (480) 990-2675

Banks or Depositories

National Bank of Arizona
21070 N. Pima Rd
Scottsdale, Arizona 85255

Signed: Patricia Nast Beran
Date Signed: 05/31/2010

(End FEC FORM 1)

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