FEC Form 1 for David Weprin for CongressForm 1 for David Weprin for Congress

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-745040

1. David Weprin for Congress

72-50 Austin Street
Second Floor
Forest Hills, NY 11375
Email: finance@weprinforcongress.com

2. Date: 09/16/2011

3. FEC Committee ID #: C00499103 This committee is a Principal Campaign Committee. Candidate: David I. Weprin
Party: Democratic Party
Office Sought: House of Representatives
State is New York in District: 09

Affiliated Committees/Organizations

Custodian of Records:

Barry A. Weprin
c/o Milberg LLP
One Pennsylvania Plaza
New York, NY 101190165
Title: Treasurer
Phone # (212) 946-9312

Treasurer:

Barry A. Weprin
c/o Milberg LLP
One Pennsylvania Plaza
New York, New York 101190165
Title: Treasurer
Phone # (212) 946-9312

Designated Agent(s):

Ronni Weprin
86-82 Palermo Street
Hollis, New York 11423
Title: Assistant Treasurer
Phone # (718) 740-6396

Banks or Depositories

Citibank NA
Branch #25
201 West 34th Street
New York, New York 10001

Signed: Barry A. Weprin
Date Signed: 09/16/2011

(End FEC FORM 1)

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