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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-112410

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1. American Chiropractic Association PAC

    1701 Clarendon Blvd
    Arlington, VA 22209
    Fax: 0-
    Email: kkrocker@amerchiro.org

2. Date: 03/19/2004

3. FEC Committee ID #: C00102764 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

American Chiropractic Association
1701 Clarendon Blvd
Arlington, Virginia 22209
Relationship: Connected Organization
Organization Type: Membership Organization

Custodian of Records:

Phone # 0

Treasurer:

Mr. Michael Perusich
3405 W 10th Street
Sedalia, Missouri 65301
Phone # (660) 829-2600

Designated Agent(s):

Banks or Depositories

Signed: Mr. Michael Perusich
Date Signed: 03/19/2004
Official Committee URL: www.acatoday.com
Official Committee FAX: 0-

FORM TEXT

(End FEC FORM 1)

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