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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-745858

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1. Adam Smith for Congress Committee

    PO Box 23626
    Federal Way, WA 98093
    Email: phil@seattlecfo.com

2. Date: 09/20/2011

3. FEC Committee ID #: C00304709 This committee is a Principal Campaign Committee. Candidate: Adam Smith
Party: Democratic Party
Office Sought: House of Representatives
State is Washington in District: 09

Affiliated Committees/Organizations

Committee ID# C00501825
Jared Polis Victory Fund 2012
PO Box 1174
Springfield, Virginia 22151
Affiliated Relationship Code: Joint Fundraising Representative

Custodian of Records:

Philip Lloyd
603 Stewart Street #819
Seattle, WA 98101
Title: Treasurer
Phone # (206) 382-5552

Treasurer:

Philip Lloyd
603 Stewart Street #819
Seattle, Washington 98101
Title: Treasurer
Phone # (206) 382-5552

Designated Agent(s):

Philip Lloyd
603 Stewart Street #819
Seattle, Washington 98101
Title: Treasurer
Phone # (206) 382-5552

Banks or Depositories

Bank of America
2100 SW 336th St
Federal Way, Washington 98023

Pacific Crest Bank
3500 188th St SW # 575
Lynnwood, Washington 98037

Bank of the Northwest
1015 A Street
Tacoma, Washington 98402


Bank of America
730 15th Street NW
Washington, DC 20005

Signed: Philip Lloyd
Date Signed: 09/20/2011
Official Committee URL: http://www.electadamsmith.com

(End FEC FORM 1)

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