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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-421942

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1. Kirkpatrick for Arizona

    PO Box 993
    Prescott, AZ 86302
    Email: Darryl@CommonCentsConsulting.net

2. Date: 07/01/2009

3. FEC Committee ID #: C00437293 This committee is a Principal Campaign Committee. Candidate: Ann Kirkpatrick
Party: Democratic Party
Office Sought: House of Representatives
State is Arizona in District: 01

Affiliated Committees/Organizations

Committee ID# C00461913
Jared Polis Victory Fund
PO Box 1174
Springfield, Virginia 22151
Affiliated Relationship Code: Joint Fundraising Representative

Custodian of Records:

Darryl R Tattrie
PO Box 12011
Casa Grande, AZ 85230
Title: Consultant
Phone # (602) 234-6821

Treasurer:

Daniel A Flores
PO Box 993
Prescott, Arizona 86302
Title: Treasurer
Phone # (602) 295-7598

Designated Agent(s):

Banks or Depositories

JP Morgan Chase
241 N. Central Ave.
Phoenix, Arizona 85004

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

Signed: Daniel A Flores
Date Signed: 07/01/2009
Official Committee URL: www.kirkpatrickforarizona.com

(End FEC FORM 1)

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