FEC Form 1 for OREGON MEDICAL POLITICAL ACTION COMMITTEEForm 1 for OREGON MEDICAL POLITICAL ACTION COMMITTEE

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-107574

1. OREGON MEDICAL POLITICAL ACTION COMMITTEE

5210 SW CORBETT AVENUE
PORTLAND, OR 972393897

NOTE: Address is different than previously reported

Fax: 5032417148
Email: sarita@theoma.org

2. Date: 12/29/2003

3. FEC Committee ID #: C00035766 This committee supports/opposes only one candidate and is NOT an Authorized Committee. Candidate Name:

Affiliated Committees/Organizations

Committee ID# C00000422
AMERICAN MEDICAL ASSOCIATION POLITICAL ACTION COMMITTEE
1101 VERMONT AVENUE NW
12TH FLOOR
WASHINGTON, DC
Organization Type: Membership Organization

Custodian of Records:

Sarita Marfin
5210 SW Corbett Ave
Portland, OR 972393897
Title: Gov't Assistant
Phone # (503) 226-1555

Treasurer:

Dr. Martin Skinner
5210 SW Corbett Ave
Portland, Oregon 972393897
Title: Treasurer
Phone # (503) 226-1555

Designated Agent(s):

Banks or Depositories

US BANK
POB 1800
St Paul, Minnesota 551010800

Signed: Dr. Martin Skinner
Date Signed: 02/02/2004
Official Committee FAX: 5032417148

(End FEC FORM 1)

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