FEC FORM 1
STATEMENT OF ORGANIZATION
FILING FEC-193915
1. American Medical Group Association PAC
3901 Hoyt AvenueEverett, WA 98290
NOTE: Address is different than previously reported
Fax: 4253395405Email: mmantei@everettclinic.com
2. Date: 12/19/2005
3. FEC Committee ID #: C00408120This committee supports/opposes more than one Federal candidate and is NOT a separate segregated fund or a party committee.
Affiliated Committees/Organizations
Custodian of Records:
Mark E. Mantei
3901 Hoyt Ave.
Everett, WA 98290
Title: Treasurer
Phone # (425) 339-5460
Treasurer:
Mark E. Mantei
3901 Hoyt Ave.
Everett, Washington 98290
Title: Treasurer
Phone # (425) 339-5460
Designated Agent(s):
Banks or Depositories
Wachovia
PO Box 563966
Charlotte, North Carolina 282623966
Signed: Mark E. Mantei
Date Signed: 12/19/2005
Official Committee FAX: 4253395405
(End FEC FORM 1)
Date Signed: 12/19/2005
Official Committee FAX: 4253395405