FEC Form 1 for American Nurses Association PACForm 1 for American Nurses Association PAC

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-409196

1. American Nurses Association PAC

8515 Georgia Avenue
Suite 400
Silver Spring, MD 209103492
Email: Angela.Song@ana.org

2. Date: 03/23/2009

3. FEC Committee ID #: C00017525 This committee is a separate segregated fund. Its connected organization is a Labor Organization
In addition, this committee is a Lobbyist/Registrant PAC.

Affiliated Committees/Organizations

American Nurses Association
8515 Georgia Ave
Ste 400
Silver Spring, Maryland 20910
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Angela Song
8515 Georgia Ave #400
Silver Spring, MD 209103492
Title: Custodian of Records

Treasurer:

Mary L. Behrens
5504 E. 22nd St
Casper, Wyoming 82609
Title: Treasurer
Phone # (307) 577-5023

Designated Agent(s):

Rose Gonzalez
8515 Georgia Ave #400
Silver Spring, Maryland 209103492
Title: Designated Agent

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-409196

1. American Nurses Association PAC

2. Date: 03/23/2009

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: Mary Behrens
Date Signed: 03/23/2009

(End FEC FORM 1)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-409196

1. American Nurses Association PAC

2. Date: 03/23/2009

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: Mary Behrens Date Signed: 03/23/2009

(End FEC FORM 1)

Signed: Mary Behrens
Date Signed: 03/23/2009