FEC Form 1 for Womble Carlyle Sandridge & Rice LLP Political Action Committee (WOMBLEPAC)Form 1 for Womble Carlyle Sandridge & Rice LLP Political Action Committee (WOMBLEPAC)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-764558

1. Womble Carlyle Sandridge & Rice LLP Political Action Committee (WOMBLEPAC)

One West Fourth Street
Winston Salem, NC 27101
Email: rcarmer@wcsr.com

2. Date: 02/06/2012

3. FEC Committee ID #: C00417386

This committee supports/opposes more than one Federal candidate and is NOT a separate segregated fund or a party committee.
In addition, this committee is a Lobbyist/Registrant PAC.

Affiliated Committees/Organizations

Custodian of Records:

Rac Carmer
One West Fourth Street
Winston Salem, NC 27101
Title: Assistant Treasurer
Phone # (336) 747-6655

Treasurer:

Hails Foster
One West Fourth Street
Winston Salem, North Carolina 27101
Title: Treasurer
Phone # (336) 721-3688

Designated Agent(s):

Rac Carmer
One West Fourth Street
Winston Salem, North Carolina 27101
Title: Assistant Treasurer
Phone # (336) 747-6655

Banks or Depositories

Wachovia Bank, N.A.
100 North Main Street
Winston Salem, North Carolina 27101

Signed: Hails Foster
Date Signed: 02/06/2012
Official Committee URL: N/A

(End FEC FORM 1)

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