FEC Form 1 for American Optometric Association Political Action CommitteeForm 1 for American Optometric Association Political Action Committee

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-248520

1. American Optometric Association Political Action Committee

1505 Prince Street
Suite 300
Alexandria, VA 22314
Email: NBrazil@aoa.org

2. Date: 10/23/2006

3. FEC Committee ID #: C00024968 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

American Optometric Association
1505 Prince Street
Suite 300
Alexandria, Virginia 22314
Relationship: Parent Organization
Organization Type: Membership Organization

Custodian of Records:

Treasurer:

Dorothy Hitchmoth, O.D.
1505 Prince Street
Suite 300
Alexandria, Virginia 22314
Title: NBrazil@aoa.org

Designated Agent(s):

Noel Brazil
1505 Prince Street
Suite 300
Alexandria, Virginia 22314
Title: AOA-PAC Director

Banks or Depositories

Bank of America
P O Box 798
Wichita, Kansas 67201

United Bank
1801 Reston Parkway
Reston, Virginia 20190

Signed: Dorothy Hitchmoth, O.D.
Date Signed: 10/23/2006

FORM TEXT

(End FEC FORM 1)

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