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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-122611

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1. Forbes for Congress

    PO Box 15100
    Chesapeake, VA 233285100
    Fax: 7574364765
    Email: treasurer@randyforbes.com

2. Date: 06/15/2004

3. FEC Committee ID #: C00365692 This committee is a Principal Campaign Committee. Candidate: J. Randy Forbes
Party: National
Office Sought: House of Representatives
State is Virginia in District: 04

Affiliated Committees/Organizations

Custodian of Records:

John G. Selph
8509 Mayland Dr
Richmond, VA 23294
Title: Treasurer
Phone # (804) 270-0791

Treasurer:

John G. Selph
8509 Mayland Dr
Richmond, Virginia 23294
Title: Treasurer
Phone # (804) 270-0791

Designated Agent(s):

Banks or Depositories

BB&T Bank
1809 Greenbriar Pkwy
Chesapeake, Virginia 23320

Wachovia Bank
100 N Main St
Winston-Salem, North Carolina 27150

Signed: John G. Selph
Date Signed: 06/15/2004
Official Committee URL: www.randyforbes.com
Official Committee FAX: 7574364765

(End FEC FORM 1)

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