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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-437966

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1. American Success Political Action Committee

    701 8th Street, NW
    Suite 500
    Washington, DC 20001

    NOTE: Address is different than previously reported

    Email: mgkelley@wms-jen.com

2. Date: 10/22/2009

3. FEC Committee ID #: C00336644

This committee supports/opposes more than one Federal candidate and is NOT a separate segregated fund or a party committee.
     In addition, this committee is a Leadership PAC.

Affiliated Committees/Organizations

David Dreier
233 Cannon HOB
Washington, DC 20515
Affiliated Relationship Code: Leadership PAC Sponsor

Custodian of Records:

Meredith Kelley
1155 21st St, NW
Suite 300
Washington, DC 20036
Phone # (202) 659-8201

Treasurer:

Walt Mix
1155 21st Street, NW
Suite 300
Washington, DC 20036

Designated Agent(s):

Banks or Depositories

Chain Bridge Bank
1445-A Laughlin Avenue
McLean, Virginia 22101

Signed: Walt Mix
Date Signed: 10/22/2009

(End FEC FORM 1)

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