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FEC Form 1 for American Medical Group Association PACForm 1 for American Medical Group Association PAC

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-193915


1. American Medical Group Association PAC

    3901 Hoyt Avenue
    Everett, WA 98290

    NOTE: Address is different than previously reported

    Fax: 4253395405
    Email: mmantei@everettclinic.com

2. Date: 12/19/2005

3. FEC Committee ID #: C00408120

This 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)


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