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FEC FORM 2

STATEMENT OF CANDIDACY

FILING FEC-812638

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1. Ann Kirkpatrick

432 West Cattle Drive Trail
Flagstaff, AZ 86001

2. Identification Number: H8AZ01104

3. Party: Democratic Party

4. Office Sought: House of Representatives

5-6. State & District of Candidate: Arizona - 1

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DESIGNATION OF PRINCIPAL CAMPAIGN COMMITTEE

7. I hereby designate the following named political committee as my Principal Campaign Committee for the 2012 election(s).

    Kirkpatrick for Arizona
    FEC ID #: C00437293

    PO Box 12011
    Casa Grande, AZ 85130

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DESIGNATION OF OTHER AUTHORIZED COMMITTEES

8. I hereby designate the following named committee, which is NOT my principal campaign committee, to receive and expend funds on behalf of my candidacy.

    Western Women Win
    FEC ID #: C00529974

    2910 E Gary Way
    Phoenix, AZ 85042

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DECLARATION OF INTENT TO EXPEND PERSONAL FUNDS (House or Senate Only)

9. I intend to expend personal funds exceeding the threshold amount (see 11 C.F.R. 400.9) by

    9A. 0.00 for the primary election, and
    9B. 0.00 for the general election

Signed as: Ann Kirkpatrick
Signed by the candidate on: 10/02/2012

Filed: 10/02/2012

(End FEC FORM 2)

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