FEC Form 1 for Tiberi for CongressForm 1 for Tiberi for Congress

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-119951

1. Tiberi for Congress

2021 E Dublin Granville Road
Suite 2000
Columbus, OH 432293522
Email: megan.baloy@pattiberi.com

2. Date: 05/17/2004

3. FEC Committee ID #: C00347492 This committee is a Principal Campaign Committee. Candidate: Patrick Tiberi
Party:
Office Sought: House of Representatives
State is Ohio in District: 12

Affiliated Committees/Organizations

Good Government 2004
1401 H Street NW
Suite 1200
Washington, DC 20005

Custodian of Records:

Mr. Jeffrey Benton
8140 Crossgate Court N
Dublin, OH 430178431

Treasurer:

Mr. Jeffrey Benton
8140 Crossgate Court N
Dublin, Ohio 430178431

Designated Agent(s):

Ms. Megan Baloy
7075 Oakstream Court
Columbus, Ohio 432352199
Title: Assistant Treasurer
Phone # (614) 519-7064

Banks or Depositories

Delaware County Bank
6156 Highland Lakes Avenue
Westerville, Ohio 43082

Wachovia Bank
740 15th Street NW
Washington, DC 20005

Signed: Jeffrey Benton
Date Signed: 05/17/2004

(End FEC FORM 1)

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