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-69138

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

P.O. Box 769
East Lansing, MI 48826

2. Date: 12/16/2002

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

Affiliated Committees/Organizations

Custodian of Records:

Kevin Kelly
120 W. Saginaw
East Lansing, MI 48840
Title: Executive Director
Phone # (517) 336-5788

Treasurer:

Dr. James Grant, MD
1574 Sodon Lake Drive
Bloomfield Hills, Michigan 48302
Title: Treasurer
Phone # (517) 336-5788

Designated Agent(s):

Banks or Depositories

Signed: Dr. James Grant, MD
Date Signed: 12/16/2002

(End FEC FORM 1)

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