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

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-98368

1. Tiberi for Congress

2021 E Dublin Granville Road
Suite 2000
Columbus, OH 432293522

2. Date: 10/16/2003

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
Relationship: Joint Fundraising

Custodian of Records:

Megan Baloy
2021 E Dublin Granville Road
Suite 2000
Columbus, OH 432293522

Treasurer:

Jeffrey Benton
8140 Crossgate Court N
Dublin, Ohio 430178431

Designated Agent(s):

Ms. Megan Baloy
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 T. Benton
Date Signed: 10/16/2003

(End FEC FORM 1)

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