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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-193723

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1. Walberg for Congress

    6769 Teachout Road
    Tipton, MI 49287
    Fax: 5174313800
    Email: timwalberg@msn.com

2. Date: 12/16/2005

3. FEC Committee ID #: C00390724 This committee is a Principal Campaign Committee. Candidate: Mr. Timothy L. Walberg
Party: National
Office Sought: House of Representatives
State is Michigan in District: 07

Affiliated Committees/Organizations

Custodian of Records:

Susan G. Walberg
6769 Teachout Rd.
Tipton, MI 49287
Title: Custodian of Records
Phone # (517) 431-2327

Treasurer:

Mr. Jeffrey A. Yeutter
4351 Evergreen Rd.
Adrian, Michigan 49221
Title: Treasurer
Phone # (517) 265-3338

Designated Agent(s):

Mrs. Carol J. Knoblauch
13260 E. Mulberry Rd.
Ottawa Lake, Michigan 49267
Title: Assistant Treasurer
Phone # (517) 486-3713

Banks or Depositories

TLC Community Credit Union
3030 S. Adrian Hwy.
Adrian, Michigan 49221

Signed: Mr. Jeffrey A. Yeutter
Date Signed: 12/16/2005
Official Committee FAX: 5174313800

(End FEC FORM 1)

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