FEC Form 1 for America Service Group Inc. Political Action CommitteeForm 1 for America Service Group Inc. Political Action Committee

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-150241

1. America Service Group Inc. Political Action Committee

105 Westpark Drive Suite 200
Brentwood, TN 37027
Fax: 0-

2. Date: 10/28/2004

3. FEC Committee ID #: C00345496 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

America Service Group Inc.
105 West Park Drive
Suite 300
Brentwood, Tennessee 37027
Relationship: Connected Organization
Organization Type: Corporation

Custodian of Records:

PAC Services LLC
7700 Old Branch Avenue
Suite D-103
Clinton, MD 20735
Title: Custodian of Records
Phone # (301) 868-1888

Treasurer:

Wade Williams
7700 Old Branch Avenue
Suite D-103
Clinton, Maryland 20735
Title: Treasurer
Phone # (301) 868-1888

Designated Agent(s):

Cresta Heltemes
7700 Old Branch Avenue
Suite D-103
Clinton, Maryland 20735
Title: Assistant Treasurer
Phone # (301) 868-1888

Banks or Depositories

Bank of America
One Bank Of America Plaza
Nashville, Tennessee 372391697

Signed: Wade Williams
Date Signed: 10/29/2004
Official Committee FAX: 0-

(End FEC FORM 1)

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