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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-761658

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1. West Hollywood Democratic Club/Beverly Hills Democratic Club

    601 N. Roxbury Dr.
    Beverly Hills, CA 90210

    NOTE: Address is different than previously reported

    Email: gary@crummittandassociates.com

    NOTE: Email address is different than previously reported

2. Date: 01/30/2012

3. FEC Committee ID #: C00352211

This committee supports/opposes more than one Federal candidate and is NOT a separate segregated fund or a party committee.

Affiliated Committees/Organizations

None
, ____

Custodian of Records:

Lillian Raffel
601 N. Roxbury Dr.
Beverly Hills, CA 90210
Title: Custodian of Records

Treasurer:

Lillian Raffel
601 N. Roxbury Dr.
Beverly Hills, California 90210
Title: Treasurer

Designated Agent(s):

Gary Crummitt
110 Pine Ave., #1010
Long Beach, California 90802
Title: Assistant Treasurer
Phone # (562) 983-0815

Banks or Depositories

City National Bank
2029 Century Park East
Los Angeles, California 90067

Signed: Lillian Raffel
Date Signed: 01/30/2012

(End FEC FORM 1)

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