FEC Form 1 for 21ST CENTURY SYSTEMS INC (21CSI) PACForm 1 for 21ST CENTURY SYSTEMS INC (21CSI) PAC

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-461499

1. 21ST CENTURY SYSTEMS INC (21CSI) PAC

2611 JEFFERSON DAVIS HWY STE 11100
ARLINGTON, VA 22202
Email: larry.jackson@21csi.com

NOTE: Email address is different than previously reported

2. Date: 04/15/2010

3. FEC Committee ID #: C00419044 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

21st Century Systems, Inc. (21CSI)
2611 Jefferson Davis Highway
Suite 11100
Arlington, Virginia 22202
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Treasurer:

Lawrence Jackson
, ____
Title: Treasurer
Phone # (703) 236-6996

Designated Agent(s):

Banks or Depositories

Chevy Chase Bank
, ____

Signed: Lawrence Jackson
Date Signed: 04/15/2010

(End FEC FORM 1)

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