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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-124622

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1. Texas Medical Association Policial Action Committee

    401 West 15th St.
    Austin, TX 78701

2. Date: 01/17/2003

3. FEC Committee ID #: C00001214 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

David Reynolds
401 West 15th St.
Austin, Texas 78701
Title: Treasurer
Phone # (512) 370-1300

Designated Agent(s):

Banks or Depositories

Signed: David Reynolds
Date Signed: 07/08/2004

(End FEC FORM 1)

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