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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-755033

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1. WEST VIRGINIANS FOR LIFE INC POLITICAL ACTION COMMITTEE

    25 CANYON ROAD
    MORGANTOWN, WV 26508
    Email: wvforlife@labs.net

2. Date: 12/19/2011

3. FEC Committee ID #: C00157537 This committee is a separate segregated fund. Its connected organization is a Membership Organization

Affiliated Committees/Organizations

West Virginians for Life, Inc.
25 Canyon Rd
Morgantown, West Virginia 26508
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Sherri Stevens
25 Canyon Rd
Morgantown, WV 26508
Title: Office Manager
Phone # (304) 594-9845

Treasurer:

Mary Anne Buchanan
25 Canyon Rd
Morgantown, West Virginia 26508
Title: Treasurer
Phone # (304) 594-9845

Designated Agent(s):

Banks or Depositories

Clear Mountain Bank
PO Box 205
Bruceton Mills, West Virginia 26525

Signed: Mary Anne Buchanan
Date Signed: 12/19/2011

(End FEC FORM 1)

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