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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-820650

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1. Jim Jordan for Congress

    1709 State Route 560 South
    Urbana, OH 43078
    Email: jkordik@rogersgreenberg.com

2. Date: 10/18/2012

3. FEC Committee ID #: C00416594 This committee is a Principal Campaign Committee. Candidate: James D. Jordan
Party:
Office Sought: House of Representatives
State is Ohio in District: 04

Affiliated Committees/Organizations

Committee ID# C00528091
2012 Jordan-Latta Victory Committee
9856 Archer Lane
Dublin, Ohio 43017
Affiliated Relationship Code: Joint Fundraising Representative

Custodian of Records:

James G Kordik
2160 Kettering Tower
Dayton, OH 45423
Title: Treasurer
Phone # (937) 223-8171

Treasurer:

James G Kordik
2160 Kettering Tower
Dayton, Ohio 45423
Title: Treasurer
Phone # (937) 223-8171

Designated Agent(s):

Banks or Depositories

Key Bank
PO Box 22114
Albany, New York 12201

Security National Bank
PO Box 351
Urbana, Ohio 43078

Signed: James G. Kordik
Date Signed: 10/18/2012

(End FEC FORM 1)

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