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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1329474

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1. OHIO SOCIETY OF ORAL AND MAXILLOFACIAL SURGEONS PAC

    18765 Shaker Blvd.
    Shaker Heights, OH 44122

    NOTE: Address is different than previously reported

    Email: kmsdental@sbcglobal.net;INFO@OH-OMS.ORG

    NOTE: Email address is different than previously reported

2. Date: 05/03/2019

3. FEC Committee ID #: C00356295 This committee is a separate segregated fund. Its connected organization is a

Affiliated Committees/Organizations

NONE
, ____

Custodian of Records:

Treasurer:

Keith Schneider
18765 Shaker Blvd.
Shaker Heights, Ohio 44122
Phone # (216) 905-9545

Designated Agent(s):

Tracy Schiefferle
PO Box 503
Dublin, Ohio 43017
Title: Director

Banks or Depositories

PNC
550 W. Market
Tiffin, Ohio 44883

Signed: Keith Schneider
Date Signed: 05/03/2019

FORM TEXT-1

(End FEC FORM 1)

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