FEC Form 1 for Ellison for CongressForm 1 for Ellison for Congress

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-774178

1. Ellison for Congress

PO Box 6072
Minneapolis, MN 55406
Email: info@keithellison.org

2. Date: 04/10/2012

3. FEC Committee ID #: C00422410 This committee is a Principal Campaign Committee. Candidate: Keith Maurice Ellison
Party: Democratic Party
Office Sought: House of Representatives
State is Minnesota in District: 05

Affiliated Committees/Organizations

Committee ID# C00501825
Jared Polis Victory Fund 2012
Po Box 1174
Springfield, Virginia 22151
Affiliated Relationship Code: Joint Fundraising Representative

Custodian of Records:

Carla Kjelberg
PO Box 6072
Minneapolis, MN 55406
Title: Treasurer
Phone # (612) 522-4416

Treasurer:

Carla Kjellberg
PO Box 6072
Minneapolis, Minnesota 55406
Title: Treasurer
Phone # (612) 522-4416

Designated Agent(s):

Shelli Hesselroth
PO Box 6072
Minneapolis, Minnesota 55406
Title: Assistant Treasurer
Phone # (612) 522-4416

Banks or Depositories

First National Bank of the Lakes
3100 Hennepin Avenue
Minneapolis, Minnesota 55408

Venture Bank
5601 Green Valley Drive
Bloomington, Minnesota 55437

Signed: Carla Kjellberg
Date Signed: 04/10/2012
Official Committee URL: http://www.keithellison.org

(End FEC FORM 1)

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