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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-410579

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1. America Forward Leadership PAC

    1831 Bay Street SE
    Washington, DC 20003

2. Date: 03/31/2009

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
REP. JOHN CONYERS, JR
8503 Marygrove Drive
Detroit, Michigan 48221
Affiliated Relationship Code: Leadership PAC Sponsor

Custodian of Records:

Diane Evans
1831 Bay Street, SE
Washington, DC 20003
Title: Treasurer
Phone # (202) 548-0880

Treasurer:

Diane Evans
1831 Bay Street, SE
Washington, DC 20003
Title: Treasurer
Phone # (202) 548-0880

Designated Agent(s):

Diane Evans
1831 Bay Street, SE
Washington, DC 20003
Title: Treasurer
Phone # (202) 548-0880

Banks or Depositories

Bank of America
201 Pennsylvania Avenue, SE
Washington, DC 20003

Signed: Diane Evans
Date Signed: 03/31/2009

(End FEC FORM 1)

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