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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-259342

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1. OHIO DENTAL ASSOCIATION POLITICAL ACTION COMMITTEE

    1370 DUBLIN ROAD
    COLUMBUS, OH 43215
    Fax: 6144860381
    Email: peg@oda.org

2. Date: 11/16/2006

3. FEC Committee ID #: C00011544 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Crowley Joseph Dr.
3475 N Bend Rd
Cincinnati, Ohio 45239
Title: Treasurer
Phone # (614) 486-2700

Designated Agent(s):

Banks or Depositories

Signed: Crowley Joseph Dr.
Date Signed: 11/16/2006
Official Committee FAX: 6144860381

(End FEC FORM 1)

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