FEC Form 1 for American College of Nurse-Midwives Midwives-PACForm 1 for American College of Nurse-Midwives Midwives-PAC

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-121094

1. American College of Nurse-Midwives Midwives-PAC

P.O. Box 14082
Washington, DC 200444082
Fax: 0-
Email: N/A

2. Date: 05/21/2004

3. FEC Committee ID #: C00358812 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

American College of Nurse-Midwives
8403 Colesville Road Suite 1550
Silver Spring, Maryland 20910
Relationship: Connected
Organization Type: Membership Organization

Custodian of Records:

Cresta Heltmes
Political Action Committee Service
7700 Old Branch Avenue Suite D-103
Clinton, MD 20735
Title: PAC Administrator
Phone # (301) 868-1888

Treasurer:

Patricia Burkhardt
246 Greene Street
New York, New York 10003
Title: Midwifery Educator
Phone # (212) 998-5039

Designated Agent(s):

Marion McCartney
8403 Colesville Road Suite 1550
Silver Spring, Maryland 20910
Title: Assistant Treasurer
Phone # (202) 728-9860

Banks or Depositories

Bank of America
7810 Old Branch Avenue
Clinton, Maryland 20735

Signed: Patricia Burkhardt
Date Signed: 05/21/2004
Official Committee URL: N/A
Official Committee FAX: 0-

(End FEC FORM 1)

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