FEC Form 1 for California Dental Association Political Action Committee - Federal FundForm 1 for California Dental Association Political Action Committee - Federal Fund

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-716378

1. California Dental Association Political Action Committee - Federal Fund

455 Capitol Mall, Suite 600
Sacramento, CA 95814

NOTE: Address is different than previously reported

Email: feccomm@bmhlaw.com

NOTE: Email address is different than previously reported

2. Date: 03/07/2011

3. FEC Committee ID #: C00005751 This committee is a separate segregated fund. Its connected organization is a Trade Association

Affiliated Committees/Organizations

California Dental Association
1201 K Street, 15th Floor
Sacramento, California 95814
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Thomas W. Hiltachk
455 Capitol Mall, Suite 600
Sacramento, CA 95814
Title: Custodian of Records
Phone # (916) 442-7757

Treasurer:

Thomas W. Hiltachk
455 Capitol Mall, Suite 600
Sacramento, California 95814
Title: Treasurer
Phone # (916) 442-7757

Designated Agent(s):

Charles H. Bell, Jr.
455 Capitol Mall, Suite 600
Sacramento, California 95814
Title: Assistant Treasurer
Phone # (916) 442-7757

Banks or Depositories

California Bank & Trust
550 South Hope Street, Suite 100
Los Angeles, California 90071

Signed: Thomas W. Hiltachk
Date Signed: 03/07/2011

FORM TEXT

(End FEC FORM 1)

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