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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-410605

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1. CITIZENS CLUB FOR GROWTH INC PAC

    2001 L St. NW
    Suite 675
    WASHINGTON, DC 20036
    Email: adamrozansky@hotmail.com

2. Date: 03/31/2009

3. FEC Committee ID #: C00346536 This committee is a separate segregated fund. Its connected organization is a Membership Organization

Affiliated Committees/Organizations

Citizens Club for Growth, Inc.
2001 L St., NW, Ste. 675
Washington, DC 20036
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Adam Rozansky
2001 L St., NW, Ste. 675
Washington, DC 20036
Title: Treasurer
Phone # (202) 887-7031

Treasurer:

Adam Rozansky
2001 L St., NW, Ste. 675
Washington, DC 20036
Title: Treasurer
Phone # (202) 887-7031

Designated Agent(s):

Chuck Pike
2001 L St., NW, Ste. 675
Washington, DC 20036
Title: VP/Asst. Treasurer
Phone # (202) 887-7031

Banks or Depositories

SunTrust Bank
1445 New York Ave., NW
Washington, DC 20005

Signed: Adam Rozansky
Date Signed: 03/31/2009
Official Committee URL: http://citizensclubforgrowth.org/

(End FEC FORM 1)

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