FEC Form 1 for Jim Himes for CongressForm 1 for Jim Himes for Congress

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-764897

1. Jim Himes for Congress

857 Post Road, #312
Fairfield, CT 06824
Email: admin@evanskatz.com

2. Date: 02/02/2012

3. FEC Committee ID #: C00434191 This committee is a Principal Campaign Committee. Candidate: Jim Himes
Party: Democratic Party
Office Sought: House of Representatives
State is Connecticut in District: 04

Affiliated Committees/Organizations

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

Custodian of Records:

Kathleen DiGennaro Warner
4 Belden Hill Lane
Wilton, CT 06897
Title: Treasurer
Phone # (203) 450-9395

Treasurer:

Kathleen DiGennaro Warner
4 Belden Hill Lane
Wilton, Connecticut 06897
Title: Treasurer
Phone # (203) 450-9395

Designated Agent(s):

Banks or Depositories

Citibank, N.A.
1345 Avenue of the Americas
New York, New York 10105

Bank of America
2 World Financial Center
New York, New York 10281

Merrill Lynch
2 World Financial Center
40th Floor
New York, New York 10281

Signed: Kathleen DiGennaro Warner
Date Signed: 02/07/2012
Official Committee URL: http://www.himesforcongress.com

(End FEC FORM 1)

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