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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-873497

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1. Adrian Smith for Congress

    3321 Avenue I
    Suite 6
    Scottsbluff, NE 693614587
    Email: committee@joinadrian.com

2. Date: 06/11/2013

3. FEC Committee ID #: C00412890 This committee is a Principal Campaign Committee. Candidate: Adrian Smith
Party: Republican Party
Office Sought: House of Representatives
State is Nebraska in District: 03

Affiliated Committees/Organizations

Committee ID# C00543314
Nebraska Joint Victory Fund
228 S Washington Street
Suite 115
Alexandria, Virginia 223145404
Affiliated Relationship Code: Joint Fundraising Representative

Custodian of Records:

Mrs. Lenora S Gompert
PO Box 46
Morrill, NE 693580046
Title: Treasurer

Treasurer:

Mrs. Lenora S Gompert
PO Box 46
Morrill, Nebraska 693580046
Title: Treasurer

Designated Agent(s):

Banks or Depositories

Platte Valley Bank
1212 Circle Drive
Scottsbluff, Nebraska 693612790

Signed: Mrs. Lenora S Gompert
Date Signed: 06/11/2013

(End FEC FORM 1)

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