FEC Form 1 for Kilroy for CongressForm 1 for Kilroy for Congress

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-752293

1. Kilroy for Congress

P.O. Box 2582
Columbus, OH 43216
Email: jay@jaypetterson.com

2. Date: 11/10/2011

3. FEC Committee ID #: C00416156 This committee is a Principal Campaign Committee. Candidate: Mary Jo Kilroy
Party: Democratic Party
Office Sought: House of Representatives
State is Ohio in District: 03

Affiliated Committees/Organizations

Custodian of Records:

Jay Petterson
P.O. Box 2582
Columbus, OH 43216
Title: Treasurer
Phone # (202) 249-2259

Treasurer:

Jay Petterson
P.O. Box 2582
Columbus, Ohio 43216
Title: Treasurer
Phone # (202) 249-2259

Designated Agent(s):

Banks or Depositories

Fifth Third Bank
PO Box 630900
Cincinnati, Ohio 45263

Signed: Jay Petterson
Date Signed: 11/10/2011

(End FEC FORM 1)

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