FEC Form 1 for National Committee to Preserve Social Security & Medicare PACForm 1 for National Committee to Preserve Social Security & Medicare PAC

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-177473

1. National Committee to Preserve Social Security & Medicare PAC

10 G St.
Suite 600
Washington, DC 200024215
Fax: 202-216-0448
Email: kimc@ncpssm.org

2. Date: 06/24/2005

3. FEC Committee ID #: C00172296 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

National Committee to Preserve Social Security and Medicare
10 G Street NE Suite 600
Washington, DC 200024215
Relationship: connected organization
Organization Type: Membership Organization

Custodian of Records:

Phone # 0

Treasurer:

Ms. Shelly Shapiro
10 G Street NE Suite 600
Washington, DC 200024215
Title: Treasurer
Phone # (202) 216-8430

Designated Agent(s):

Christine Kim
10 G Street NE Suite 600
Washington, DC 200024215
Title: Assistant Treasurer
Phone # (202) 216-8428

Banks or Depositories

Suntrust Bank
1445 New York Avenue NW
Washington, DC 200052108

Signed: Ms. Shelly Shapiro
Date Signed: 06/24/2005
Official Committee FAX: 202-216-0448

(End FEC FORM 1)

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