FEC Form 1 for Andre Carson for CongressForm 1 for Andre Carson for Congress

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-431242

1. Andre Carson for Congress

603 East Washington #100
Indianapolis, IN 46204
Email: treasurer@andrecarson.com

2. Date: 08/28/2009

3. FEC Committee ID #: C00442921 This committee is a Principal Campaign Committee. Candidate: Andre Carson
Party: Democratic Party
Office Sought: House of Representatives
State is Indiana in District: 07

Affiliated Committees/Organizations

Committee ID# C00461228
KEEP INDIANA BLUE
PO BOX 83142
GAITHERSBURG, Maryland 20883
Affiliated Relationship Code: Joint Fundraising Representative

Custodian of Records:

Kim Hood Jacobs
603 East Washington #100
Indianapolis, IN 46204
Title: Treasurer

Treasurer:

Kim Hood Jacobs
603 East Washington #100
Indianapolis, Indiana 46204
Title: Treasurer
Phone # (317) 226-9400

Designated Agent(s):

Banks or Depositories

JPMorganChase
20 West 16th Street
Indianapolis, Indiana 46202

Bank of America
4201 Connecticut Avenue NW
Washington, DC 20008

Signed: Kim Hood Jacobs
Date Signed: 08/28/2009
Official Committee URL: www.andrecarsonforcongress.com

(End FEC FORM 1)

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