FEC Form 1 for JD Hayworth For CongressForm 1 for JD Hayworth For Congress

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-229513

1. JD Hayworth For Congress

14300 N. Northsight Blvd. #105
Scottsdale, AZ 85260
Fax: 530-934-5776

2. Date: 07/20/2006

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

Committee ID# C00426239
ROMP IV 2006
228 S. Washington Street Suite 11
Alexandria, Virginia 22314
Relationship: Joint Fundraising Rep

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

BB&T
1909 K Street NW
Washington, DC 20006

Compass Bank
23305 North Pima Road
Scottsdale, Arizona 85255

Johnson Bank
8700 East Pinnacle Peak
Scottsdale, Arizona 85255

Signed: Kelly Lawler
Date Signed: 07/20/2006
Official Committee FAX: 530-934-5776

(End FEC FORM 1)

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