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FEC Disclosure Form 1M for FREE STATE PACForm 1M for FREE STATE PAC

FEC FORM 1M

NOTIFICATION OF MULTICANDIDATE STATUS

FILING FEC-771623


1. FREE STATE PAC

P.O. BOX 2712
TOPEKA, KS 66601

2. FEC Committee ID #: C00455717

3. This is NOT a state party committee

4. STATUS BY AFFILIATION:

The committee submitted its Statement of Organization (FEC FORM 1)
on ________________________ and simultaneously qualified as a multicandidate committee through its
affiliation with:

Committee Name: ________________________
FEC Identification Number: _______________________

5. STATUS BY QUALIFICATION:

(a) Candidates: The committee has made contributions to the five federal candidates listed below:


NameOffice SoughtState/DistrictDate
(i) LYNN JENKINS
House of Representatives
Kansas/02
03/30/2009
(ii) DOUGLAS L. MR. HOFFMAN
House of Representatives
New York/23
11/02/2009
(iii) CHARLES F. BASS
House of Representatives
New Hampshire/02
11/03/2009
(iv) SCOTT P BROWN
Senate
Massachusetts/00
01/14/2010
(v) COBURN FOR SENATE 2010
Senate
Oklahoma/00
06/28/2010

(b) Contributors: The committee received a contribution from its 51st contributor on: 05/04/2011

(c) Registration: The committee has been registered for at least 6 months. FEC FORM 1 was submitted on: 10/03/2008

(d) Qualification: The committee met the above requirements on: 05/04/2011

Treasurer: James Tice Clark
Date Signed: 03/20/2012

(End FEC FORM 1M)


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