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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-118445

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1. JD Hayworth For Congress

    14300 N. Northsight Blvd. #105
    Scottsdale, AZ 85260
    Email: jdmoney99@aol.com

2. Date: 04/27/2004

3. FEC Committee ID #: C00287987 This committee is a Principal Campaign Committee. Candidate: JD Hayworth
Party: National
Office Sought: House of Representatives
State is Arizona in District: 5

Affiliated Committees/Organizations

Custodian of Records:

Kelly Lawler
P.O. Box 984
Willows, CA 95988
Title: Treasurer
Phone # (530) 934-5823

Treasurer:

Kelly Lawler
P.O. Box 984
Willows, California 95988
Title: Treasurer
Phone # (530) 934-5823

Designated Agent(s):

Kelly Lawler
P.O. Box 984
Willows, California 95988
Title: Treasurer
Phone # (530) 934-5823

Banks or Depositories

Bank One
P.O. Box 71
Phoenix, Arizona 85001

Signed: Kelly Lawler
Date Signed: 04/27/2004
Official Committee URL: www.jdhayworth.com

(End FEC FORM 1)

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