FEC FORM 1
STATEMENT OF ORGANIZATION
FILING FEC-759451
1. America Forward Leadership PAC
PO Box 70980Washington, DC 20024
NOTE: Address is different than previously reported
Email: admin@evanskatz.comNOTE: Email address is different than previously reported
2. Date: 01/25/2012
3. FEC Committee ID #: C00403675This 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.
8503 Marygrove Drive
Detroit, Michigan 48221
Affiliated Relationship Code: Leadership PAC Sponsor
Custodian of Records:
Diane Evans
PO Box 70980
Washington, DC 20024
Title: Treasurer
Phone # (202) 548-0880
Treasurer:
Diane Evans
PO Box 70980
Washington, DC 20024
Title: Treasurer
Phone # (202) 548-0880
Designated Agent(s):
Banks or Depositories
Bank of America
201 Pennsylvania Avenue, SE
Washington, DC 20003
Signed: Diane Evans
Date Signed: 01/25/2012
(End FEC FORM 1)
Date Signed: 01/25/2012