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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-313257

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1. DAN LIPINSKI FOR CONGRESS

    5838 SOUTH ARCHER AVENUE
    CHICAGO, IL 60638

    NOTE: Address is different than previously reported

    Fax: 7737671720
    Email: dennis@kennycpa.com

2. Date: 12/17/2007

3. FEC Committee ID #: C00405431 This committee is a Principal Campaign Committee. Candidate:
Party: National
Office Sought: House of Representatives
State is Illinois in District: 03

Affiliated Committees/Organizations

Custodian of Records:

Dan W. Lipinski
4501 Grand
Western Springs, IL 60558
Title: Treasurer
Phone # (773) 767-7019

Treasurer:

Dan W. Lipinski
4501 Grand
Western Springs, Illinois 60558
Title: Treasurer
Phone # (773) 767-7019

Designated Agent(s):

Dan W. Lipinski
4501 Grand
Western Springs, Illinois 60558
Title: Treasurer
Phone # (773) 767-7019

Banks or Depositories

Western Springs National Bank & Trust
4456 Wolf Road
Western Springs, Illinois 60558

Signed: Dan W. Lipinski
Date Signed: 12/17/2007
Official Committee URL: danlipinskiforcongresscommittee.com
Official Committee FAX: 7737671720

(End FEC FORM 1)

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