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FEC FORM 2

STATEMENT OF CANDIDACY

FILING FEC-841225

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1. Patrick J. Tiberi

6830 Mahogany Drive
Galena, OH 430218059

2. Identification Number: H0OH12062

3. Party: Republican Party

4. Office Sought: House of Representatives

5-6. State & District of Candidate: Ohio - 12

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DESIGNATION OF PRINCIPAL CAMPAIGN COMMITTEE

7. I hereby designate the following named political committee as my Principal Campaign Committee for the 2014 election(s).

    Tiberi for Congress
    FEC ID #: C00347492

    2931 E Dublin Granville Road
    Suite 190
    Columbus, OH 432312098

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DESIGNATION OF OTHER AUTHORIZED COMMITTEES

8. I hereby designate the following named committee, which is NOT my principal campaign committee, to receive and expend funds on behalf of my candidacy.

    Secure the Majority Fund
    FEC ID #: C00511865

    228 S Washington Street
    Suite 115
    Alexandria, VA 223145404

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DECLARATION OF INTENT TO EXPEND PERSONAL FUNDS (House or Senate Only)

9. I intend to expend personal funds exceeding the threshold amount (see 11 C.F.R. 400.9) by

    9A. 0.00 for the primary election, and
    9B. 0.00 for the general election

Signed as: Patrick J. Tiberi
Signed by the candidate on: 12/07/2012

Filed: 12/07/2012

(End FEC FORM 2)

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