FEC Form 1 for COSTELLO FOR CONGRESS COMMITTEEForm 1 for COSTELLO FOR CONGRESS COMMITTEE

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-169793

1. COSTELLO FOR CONGRESS COMMITTEE

PO BOX 8250
BELLEVILLE, IL 62222
Fax: 6183979603
Email: gotv5@aol.com

2. Date: 04/09/2005

3. FEC Committee ID #: C00238444 This committee supports/opposes only one candidate and is NOT an Authorized Committee. Candidate Name: JERRY F. COSTELLO

Affiliated Committees/Organizations

Custodian of Records:

DANIEL COSTELLO
P. O. BOX 8250
BELLEVILLE, IL 62222
Title: TREASURER
Phone # (618) 397-9599

Treasurer:

DANIEL COSTELLO
PO BOX 8250
BELLEVILLE, Illinois 62222
Title: TREASURER
Phone # (618) 397-9599

Designated Agent(s):

DANIEL COSTELLO
P. O. BOX 8250
BELLEVILLE, Illinois 62222
Title: TREASURER
Phone # (618) 397-9599

Banks or Depositories

WEST POINTE BANK
5701 WEST MAIN STREET
BELLEVILLE, Illinois 62223

Signed: Daniel E. Costello
Date Signed: 04/09/2005
Official Committee URL: www.costelloforcongress.com
Official Committee FAX: 6183979603

(End FEC FORM 1)

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