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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1368738

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1. PIEDMONT STONE CENTER PLLC POLITICAL ACTION COMMITTEE

    1605 WESTBROOK PLAZA DR
    SUITE 203
    WINSTON-SALEM, NC 27103
    Email: KFLIPPIN@PDLLC.com

2. Date: 01/06/2020

3. FEC Committee ID #: C00387696 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

Committee ID# C00387696
PIEDMONT STONE CENTER PLLC POLITICAL ACTION COMMITTEE
1605 WESTBROOK PLAZA DR
SUITE 203
WINSTON-SALEM, North Carolina 27103
Affiliated Relationship Code: Connected Organization

Custodian of Records:

MRS KIMBERLY RAE FLIPPIN
1020 RED COAT RD
YADKINVILLE, NC 27055
Title: COO
Phone # (336) 714-2520

Treasurer:

MR CHARLES HUBERT HAUSER
948 WELLINGTON RD
WINSTON SALEM, North Carolina 27106
Title: CEO
Phone # (336) 714-2600

Designated Agent(s):

KIMBERLY RAE FLIPPIN
1020 RED COAT RD
YADKINVILLE, North Carolina 27055
Title: COO
Phone # (336) 714-2520

Banks or Depositories

Wells Fargo
100 N Main St
Winston Salem, North Carolina 27101

Signed: MR CHARLES HUBERT HAUSER
Date Signed: 01/06/2020

(End FEC FORM 1)

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