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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-166849

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1. Placer County Republican Party (Federal Acct.)

    18505 Sierra Ranch Road
    Colfax, CA 957139649
    Email: dean@gfb4advice.com

2. Date: 03/08/2005

3. FEC Committee ID #: C00395590 This committee is a Republican Party committee of the Local Party.

Affiliated Committees/Organizations

California Republican Party
1903 W. Magnolia Blvd.
Burbank, California 91506
Relationship: Affiliated State Party Committee

Custodian of Records:

Dean Forman
18505 Sierra Ranch Road
Colfax, CA 957139649

Treasurer:

Dean Forman
18505 Sierra Ranch Road
Colfax, California 957139649
Title: Treasurer
Phone # (530) 878-0215

Designated Agent(s):

Banks or Depositories

Placer Sierra Bank
49 Lincoln Way
Auburn, California 956034803

Signed: Dean Forman
Date Signed: 03/08/2005

(End FEC FORM 1)

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