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

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-438030

1. Tiberi for Congress

2931 E Dublin Granville Road
Suite 190
Columbus, OH 432312098
Email: kristen.frissora@pattiberi.com

2. Date: 10/23/2009

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

Affiliated Committees/Organizations

Committee ID# C00468785
Patriot Day II Committee
228 S Washington Street
Suite 115
Alexandria, Virginia 223145404
Affiliated Relationship Code: Joint Fundraising Representative

Custodian of Records:

Kristen Frissora
2931 E Dub Granvl Road
Suite 190
Columbus, OH 432312098
Title: Custodian of Records

Treasurer:

Jeffrey Benton
6791 Fall Brook Trail
Delaware, Ohio 430156538
Title: Treasurer
Phone # (740) 657-7900

Designated Agent(s):

Kristen Frissora
2931 E Dub Granvl Road
Suite 190
Columbus, Ohio 432312098
Title: Assistant Treasurer

Banks or Depositories

Delaware County Bank
6156 Highland Lakes Avenue
Westerville, Ohio 430827737

BB&T
1909 K Street NW
Washington, DC 200061152

Signed: Jeffrey Benton
Date Signed: 10/23/2009

(End FEC FORM 1)

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