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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-94428

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1. Independence Party of Minnesota

    PO Box 40495
    St Paul, MN 55104
    Email: Treasurer@mnip.org

2. Date: 08/26/2003

3. FEC Committee ID #: C00305268 This committee is a committee of the State Party.

Affiliated Committees/Organizations

Custodian of Records:

Daniel Justesen
3536 46th Ave. S.
Minneapolis, MN 55406
Title: Treasurer

Treasurer:

Daniel Justesen
3536 46th Ave. S.
Minneapolis, Minnesota 55406
Title: Treasurer

Designated Agent(s):

Mark Priore
982 Englewood Ave
St Paul, Minnesota 55104
Title: Deputy Treasurer
Phone # (651) 489-5965

Banks or Depositories

Signed: Daniel Justesen
Date Signed: 08/26/2003
Official Committee URL: www.mnip.org

(End FEC FORM 1)

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