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

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-181954

1. Tiberi for Congress

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

2. Date: 07/22/2005

3. FEC Committee ID #: C00347492 This committee is a Principal Campaign Committee. Candidate: Patrick J. 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:

Jeffrey Benton
8140 Crossgate Court N
Dublin, OH 430178431

Treasurer:

Jeffrey Benton
8140 Crossgate Court N
Dublin, Ohio 430178431
Title: Treasurer
Phone # (614) 791-0484

Designated Agent(s):

Ben Kanzeg
2021 E Dublin Granville Road
Suite 2000
Columbus, Ohio 432293522
Title: Assistant Treasurer

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: 07/22/2005

(End FEC FORM 1)

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