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-858889

1. American Optometric Association Political Action Committee

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

2. Date: 03/24/2009

3. FEC Committee ID #: C00024968 This committee is a separate segregated fund. Its connected organization is a Membership Organization
In addition, this committee is a Lobbyist/Registrant PAC.

Affiliated Committees/Organizations

American Optometric Association
1505 Prince Street
Suite 300
Alexandria, Virginia 22314
Affiliated Relationship Code: Leadership PAC Sponsor

Custodian of Records:

Treasurer:

Fred Dubrick, O.D.
1505 Prince Street
Suite 300
Alexandria, Virginia 22314
Title: Treasurer AOA-PAC
Phone # (703) 837-1376

Designated Agent(s):

Julie L Trute
1505 Prince Street
Suite 300
Alexandria, Virginia 22314
Title: AOA-PAC Director
Phone # (703) 837-1376

Julie L Trute
1505 Prince Street
Suite 300
Alexandria, Virginia 22314
Title: AOA-PAC Director
Phone # (703) 837-1376

Banks or Depositories

Bank of America
P O Box 798
Wichita, Kansas 67201

Wachovia Bank
P O Box 563966
Charlotte, North Carolina 282563966

United Bank
1801 Reston Parkway
Reston, Virginia 20190

Signed: Fred Dubrick, O.D.
Date Signed: 03/24/2009

FORM TEXT

(End FEC FORM 1)

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