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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-153234

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1. RetireSafe PAC

    NOTE:Commmittee Name is different than previously reported

    2915 Hunter Mill Road
    Suite 23
    Oakton, VA 22124
    Fax: 7033198842
    Email: chardin@retiresafe.org

2. Date: 11/23/2004

3. FEC Committee ID #: C00354050 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

RetireSafe
2915 Hunter Mill Road Suite 23
Oakton, Virginia 22124
Relationship: Connected Org
Organization Type: Membership Organization

Custodian of Records:

Charles Hardin
2915 Hunter Mill Road
Oakton, VA 22124

Treasurer:

Charles Hardin
2915 Hunter Mill Road
Oakton, Virginia 22124

Designated Agent(s):

Banks or Depositories

Wachovia
P.O. Box 8502
Charlotte, North Carolina 282623966

Signed: Charles Hardin
Date Signed: 12/01/2004
Official Committee FAX: 7033198842

(End FEC FORM 1)

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