FEC Form 1 for Collins for CongressForm 1 for Collins for Congress

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-826888

1. Collins for Congress

PO Box 386
Clarence, NY 140310386
Email: ccc9660@prodigy.net

2. Date: 04/18/2012

3. FEC Committee ID #: C00520379 This committee is a Principal Campaign Committee. Candidate: Christopher C Collins
Party: Republican Party
Office Sought: House of Representatives
State is New York in District: 27

Affiliated Committees/Organizations

Committee ID# C00529826
Western New York Victory Fund
2470 Daniels Bridge Road
Suite 121
Athens, Georgia 306066191
Affiliated Relationship Code: Joint Fundraising Representative

Committee ID# C00525360
Young Guns 2012 Round 3
228 S Washington Street
Suite 115
Alexandria, Virginia 223145404
Affiliated Relationship Code: Joint Fundraising Representative

Custodian of Records:

Ms. Jocelyn D. Jakubus
68 Brockett Drive
Tonawanda, NY 142231421
Title: Treasurer
Phone # (716) 864-4314

Treasurer:

Ms. Jocelyn D. Jakubus
68 Brockett Drive
Tonawanda, New York 142231421
Title: Treasurer
Phone # (716) 864-4314

Designated Agent(s):

Banks or Depositories

M&T Bank
7300 Transit Road
Williamsville, New York 142216020

SunTrust Bank
PO Box 4418
Atlanta, Georgia 303024418

Signed: Ms. Jocelyn D. Jakubus
Date Signed: 10/25/2012

(End FEC FORM 1)

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