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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-431969

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1. Andre Carson for Congress

    P.O. Box 1863
    Indianapolis, IN 46206

    NOTE: Address is different than previously reported

    Email: treasurer@andrecarson.com

2. Date: 09/10/2009

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
P.O. Box 1863
Indianapolis, IN 46206
Title: Treasurer

Treasurer:

Kim Hood Jacobs
P.O. Box 1863
Indianapolis, Indiana 46206
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: 09/10/2009
Official Committee URL: www.andrecarsonforcongress.com

(End FEC FORM 1)

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