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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-443935

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1. North Carolina Dental PAC

    1600 Evans Road
    Cary, NC 27513
    Email: pallen@ncdental.org

2. Date: 01/01/2010

3. FEC Committee ID #: C00012211 This committee is a separate segregated fund. Its connected organization is a Membership Organization

Affiliated Committees/Organizations

Committee ID# C00012211
North Carolina Dental PAC
1600 Evans Road
Cary, North Carolina 27513
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Mrs. Priscilla Allen
1600 Evans Road
Cary, NC 27513
Phone # (919) 677-1396

Treasurer:

Dr. George Sutton
218 Professional Circle
Morehead City, North Carolina 28557
Title: Treasurer
Phone # (252) 726-2360

Designated Agent(s):

Mrs. Priscilla Allen
1600 Evans Road
Cary, North Carolina 27513

Banks or Depositories

BB&T Bank
200 East Chatham Street
Cary, North Carolina 27511

Signed: Dr. George Sutton
Date Signed: 01/07/2010
Official Committee URL: www.ncds.org

(End FEC FORM 1)

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