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

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-837270

1. Ellison for Congress

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

2. Date: 12/05/2012

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

Committee ID# C00522433
Progressives Win 2012
1 Park Row 5th Fl
Providence, Rhode Island 02906
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

Bank of America
730 15th Street NW
Washington, DC 20005

Citizens Bank
1 Citizens Plaza
Providence, Rhode Island 02903

Signed: Carla Kjellberg
Date Signed: 12/05/2012
Official Committee URL: http://www.keithellison.org

(End FEC FORM 1)

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