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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1175767

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1. FOURTH CONGRESSIONAL DISTRICT REPUBLICAN PARTY

    2905 Nina Court
    Raleigh, NC 27603

    NOTE: Address is different than previously reported

    Email: sampotter595@gmail.com

    NOTE: Email address is different than previously reported

2. Date: 07/28/2017

3. FEC Committee ID #: C00339606 This committee is a committee of the Party.

Affiliated Committees/Organizations

Committee ID# C00038505
NORTH CAROLINA REPUBLICAN PARTY
1506 HILLSBOROUGH STREET
RALEIGH, North Carolina 27605
Affiliated Relationship Code: Affiliated Committee

Custodian of Records:

Samuel Potter
2905 Nina Court
Raleigh, NC 27603
Title: Treasurer
Phone # (704) 659-4732

Treasurer:

Samuel Potter
2905 Nina Court
Raleigh, North Carolina 27603
Title: Treasurer
Phone # (704) 659-4732

Designated Agent(s):

Charles Hellwig
1353 Spring Lawn Court
Raleigh, North Carolina 27609
Title: Chairman

Banks or Depositories

SunTrust Bank
PO Box 305183
Nashville, North Carolina 37230

Signed: Samuel Potter
Date Signed: 07/28/2017

(End FEC FORM 1)

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