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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1020466

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1. America Forward Leadership PAC

    PO Box 75357
    Washington, DC 20002

    NOTE: Address is different than previously reported

    Email: admin@evanskatz.com

2. Date: 08/01/2015

3. FEC Committee ID #: C00403675

This committee supports/opposes more than one Federal candidate and is NOT a separate segregated fund or a party committee.
     In addition, this committee is a Leadership PAC.

Affiliated Committees/Organizations

Candidate ID# H6MI01028
John Conyers, Jr.
2727 West 7 Mile Rd
Detroit, Michigan 48221
Affiliated Relationship Code: Leadership PAC Sponsor

Custodian of Records:

Diane Evans
PO Box 75357
Washington, DC 20002
Title: Treasurer
Phone # (202) 548-0880

Treasurer:

Diane Evans
PO Box 75357
Washington, DC 20002
Title: Treasurer
Phone # (202) 548-0880

Designated Agent(s):

Banks or Depositories

PNC Bank
1799 Columbia Road NW
Washington, DC 20009

Signed: Diane Evans
Date Signed: 08/06/2015

(End FEC FORM 1)

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