FEC Form 1 for Alaska State Medical Association Political Action Committee (ALPAC)Form 1 for Alaska State Medical Association Political Action Committee (ALPAC)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-265360

1. Alaska State Medical Association Political Action Committee (ALPAC)

NOTE:Commmittee Name is different than previously reported

4107 Laurel Street
Anchorage, AK 99508
Fax: 9075612063
Email: asma@alaska.net

2. Date: 12/11/2006

3. FEC Committee ID #: C00001461 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

Alaska State Medical Association
4107 Laurel St
Anchorage, Alaska 99508
Relationship: Connected
Organization Type: Membership Organization

Custodian of Records:

Mr. James J Jordan
4907 Wesleyan Drive
Anchorage, AK 99508
Title: Exec Director
Phone # (907) 562-0304

Treasurer:

Dr. Dwight Ellerbe
4107 Laurel
Anchorage, Alaska 99508
Title: Treasurer
Phone # (907) 563-0304

Designated Agent(s):

Banks or Depositories

Wells Fargo Bank
P. O. Box 196124 MAC K33212-011
Anchorage, Alaska 995196127

Signed: Dr. Dwight Ellerbe
Date Signed: 12/11/2006
Official Committee FAX: 9075612063

(End FEC FORM 1)

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