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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-769059

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1. Laguna Woods Democratic Club

    11 Largo Street
    Laguna Niguel, CA 92677

    NOTE: Address is different than previously reported

    Email: giovanii@campaigntreasurer.com

    NOTE: Email address is different than previously reported

2. Date: 03/05/2012

3. FEC Committee ID #: C00447185

This committee supports/opposes more than one Federal candidate and is NOT a separate segregated fund or a party committee.

Affiliated Committees/Organizations

NONE
, ____

Custodian of Records:

Leroy Harrell
11 Largo Street
Laguna Niguel, CA 92677
Title: Treasurer
Phone # (949) 510-5567

Treasurer:

Leroy Harrell
11 Largo Street
Laguna Niguel, California 92677
Title: Treasurer
Phone # (949) 510-5567

Designated Agent(s):

Banks or Depositories

US Bank
24340 El Toro Road
Laguna Woods, California 92673

Signed: Leroy Harell
Date Signed: 03/05/2012

(End FEC FORM 1)

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