FEC Form 1 for New Jersey Medical Political Action CommitteeForm 1 for New Jersey Medical Political Action Committee

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-738163

1. New Jersey Medical Political Action Committee

2 Princess Road
Lawrenceville, NJ 08648
Email: aclarke@msnj.org

2. Date: 07/22/2011

3. FEC Committee ID #: C00039123 This committee is a separate segregated fund. Its connected organization is a Trade Association
In addition, this committee is a Lobbyist/Registrant PAC.

Affiliated Committees/Organizations

Committee ID# C00039123
New Jersey Medical Action Committee
2 Princess Road
Lawrenceville, New Jersey 08648
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Anita Clarke
2 Princess Road
Lawrenceville, NJ 08648
Title: Administrative Asst.
Phone # (609) 896-1766

Treasurer:

Lawrence Downs
2 Princess Road
Lawrenceville, New Jersey 08648
Title: Treasurer
Phone # (609) 896-1766

Designated Agent(s):

Banks or Depositories

Morgan Stanley Smith Barney
4259 Swamp Road
Doylestown, Pennsylvania 18902

Signed: Lawrence Downs
Date Signed: 07/22/2011
Official Committee URL: http://www.msnj.org

(End FEC FORM 1)

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