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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-45099

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1. New Jersey Medical Political Action Committee (JEMPAC)

    Two Princess Road
    Lawrenceville, NJ 08648

2. Date: 07/21/2002

3. FEC Committee ID #: C00039123 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Capelli John P MD
35 Kings Hwy East
Haddonfield, New Jersey 08033
Title: Treasurer
Phone # (856) 757-3903

Designated Agent(s):

Banks or Depositories

Signed: Capelli John P MD
Date Signed: 07/25/2002

(End FEC FORM 1)

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