FEC Form 1 for AMERICAN ASSOCIATION OF ORAL AND MAXILLOFACIAL SURGEONS POLITICAL ACTION COMMITTEEForm 1 for AMERICAN ASSOCIATION OF ORAL AND MAXILLOFACIAL SURGEONS POLITICAL ACTION COMMITTEE

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-764600

1. AMERICAN ASSOCIATION OF ORAL AND MAXILLOFACIAL SURGEONS POLITICAL ACTION COMMITTEE

9700 WEST BRYN MAWR AVE.
ROSEMONT, IL 60018
Email: tmacino@aaoms.org

2. Date: 02/06/2012

3. FEC Committee ID #: C00005660 This committee is a separate segregated fund. Its connected organization is a Membership Organization

Affiliated Committees/Organizations

American Association of Oral and Maxillofacial Surgeons
9700 W. Bryn Mawr
Rosemont, Illinois 60018
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Treasurer:

Lawrence Chewning
901 E Cheves St
Suite 440
Florence, South Carolina 29506
Title: Treasurer
Phone # (847) 678-6200

Designated Agent(s):

Banks or Depositories

The Northern Trust Company
1501 Woodfield Road
Schaumburg, Illinois 60173

DWS Scudder Investments Servic
P.O. Box 219154
Kansas City, Missouri 641219154

Signed: Lawrence Chewning
Date Signed: 02/06/2012

(End FEC FORM 1)

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