FEC Form 1 for Michigan Doctors Political Action Committee - Michigan State Medical SocietyForm 1 for Michigan Doctors Political Action Committee - Michigan State Medical Society

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-262214

1. Michigan Doctors Political Action Committee - Michigan State Medical Society

P.O. Box 769
East Lansing, MI 48826
Fax: 5173372490
Email: jgass@msms.org

2. Date: 12/06/2006

3. FEC Committee ID #: C00001180 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Scot F. Goldberg MD
, ____
Title: Secretary/Treasurer
Phone # (517) 336-5752

Designated Agent(s):

Banks or Depositories

Capitol National Bank
200 Washington Square North
P.O. Box 26068
Lansing, Michigan 489012577

Signed: GOLDBERG SCOT
Date Signed: 12/06/2006
Official Committee URL: WWW.mdpac.org
Official Committee FAX: 5173372490

(End FEC FORM 1)

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