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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-100977

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1. OmniAmerican PAC

    P. O. Box 150099
    Fort Worth, TX 76108
    Fax: 8173674891
    Email: rhonda.cobern@omniamerican.org

2. Date: 12/03/2003

3. FEC Committee ID #: C00385161 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

OmniAmerican Credit Union
P. O. Box 150099
Fort Worth, Texas 76108
Relationship: Connected
Organization Type: Corporation

Custodian of Records:

Gregory W. Higgins
P. O. Box 150099
Fort Worth, TX 76108
Title: Assistant Treasurer
Phone # (817) 367-5491

Treasurer:

David Pickney
P. O. Box 150099
Fort Worth, Texas 76108
Title: Treasurer
Phone # (817) 367-5660

Designated Agent(s):

Rhonda Cobern
P. O. Box 150099
Fort Worth, Texas 76108
Title: PAC Agent
Phone # (817) 367-5660

Banks or Depositories

OmniAmerican Credit Union
P. O. Box 150099
Fort Worth, Texas 76108

Signed: David Pickney
Date Signed: 12/04/2003
Official Committee URL: www.omniamerican.org
Official Committee FAX: 8173674891

(End FEC FORM 1)

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