FEC Form 1 for DAVE CAMP FOR CONGRESS 2004Form 1 for DAVE CAMP FOR CONGRESS 2004

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-69069

1. DAVE CAMP FOR CONGRESS 2004

NOTE:Commmittee Name is different than previously reported

5915 EASTMAN AVE. SUITE 100
MIDLAND, MI 48640
Email: jmedema@burnsidelang.com

2. Date:

3. FEC Committee ID #: C00347476 This committee is a Principal Campaign Committee. Candidate: David Lee Camp
Party: National
Office Sought: House of Representatives
State is Michigan in District: 04

Affiliated Committees/Organizations

Custodian of Records:

Gwen D. Lang
5915 Eastman Ave
Suite 100
Midland, MI 48640
Title: Treasurer
Phone # (989) 835-7721

Treasurer:

Gwen D. Lang
5915 Eastman AVe
Suite 100
Midland, Michigan 48640
Title: Treasurer
Phone # (989) 835-7721

Designated Agent(s):

Banks or Depositories

Chemical Bank & Trust
333 E. Main Street
Midland, Michigan 48640

Signed: GWEN D. LANG
Date Signed: 12/13/2002
Official Committee URL: www.davecamp4congress.org

(End FEC FORM 1)

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