FEC Form 1 for Kirkpatrick for ArizonaForm 1 for Kirkpatrick for Arizona

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-455308

1. Kirkpatrick for Arizona

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

2. Date: 03/11/2010

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

Committee ID# C00468892
Independent Voices for Arizona
2910 E Gary Way
Phoenix, Arizona 85042
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

Wells Fargo, NA
100 W. Washington St.
Phoenix, Arizona 85003

Signed: Daniel A Flores
Date Signed: 03/11/2010
Official Committee URL: www.kirkpatrickforarizona.com

(End FEC FORM 1)

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