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-998273

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: 01/30/2015

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:

Murray Jacobs
800 Creekside Dr
Redlands, California 92373
Title: Treasurer
Phone # (847) 678-6200

Designated Agent(s):

Banks or Depositories

The Northern Trust Company
P.O. Box 92000
Chicago, Illinois 606752000

MB Financial Bank
6111 North River Rd
Rosemont, Illinois 60018

Signed: Murray Jacobs
Date Signed: 03/19/2015

(End FEC FORM 1)

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