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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-63826

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1. Gene Douglass for Congress

    120 Fisherville Road
    #179
    Concord, NH 03303
    Email: gene@douglass2004.org

2. Date: 11/06/2002

3. FEC Committee ID #: C00372250 This committee is a Principal Campaign Committee. Candidate: Mr. Eugene Douglass
Party: National
Office Sought: House of Representatives
State is New Hampshire in District: 2

Affiliated Committees/Organizations

Committee ID# C00334995
Eugene F Douglass For The US Senate Campaign Committee
120 Fisherville Road
#179
Concord, New Hampshire 03303
Relationship: Affiliated Committee

Custodian of Records:

Mr. Eugene Douglass
120 Fisherville Road
#179
Concord, NH 03303
Title: Candidate
Phone # (603) 225-9206

Treasurer:

Mr. Eugene Douglass
120 Fisherville Road
#179
Concord, New Hampshire 03303
Title: Treasurer
Phone # (603) 225-9206

Designated Agent(s):

Banks or Depositories

Merrimack County Savings Bank
89 N Main St.
Concord, New Hampshire 03301

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

Signed: Mr. Eugene Douglass
Date Signed: 11/06/2002
Official Committee URL: http://www.douglass2004.org

(End FEC FORM 1)

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