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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-857681

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1. FREE STATE PAC

    P.O. BOX 2712
    TOPEKA, KS 66601
    Email: jtccpa09@att.net

    NOTE: Email address is different than previously reported

2. Date: 02/20/2013

3. FEC Committee ID #: C00455717

This committee supports/opposes more than one Federal candidate and is NOT a separate segregated fund or a party committee.
     In addition, this committee is a Leadership PAC.

Affiliated Committees/Organizations

Candidate ID# S0KS00091
JERRY MORAN
P.O. 1151
HAYS, Kansas 67601
Affiliated Relationship Code: Leadership PAC Sponsor

Custodian of Records:

James Clark
2116 Inverness Drive
Lawrence, KS 66047
Title: Treasurer
Phone # (785) 843-4551

Treasurer:

James Clark
2116 Inverness Drive
Lawrence, Kansas 66047
Title: Treasurer
Phone # (785) 843-4551

Designated Agent(s):

James Clark
2116 Inverness Drive
Lawrence, Kansas 66047
Title: Treasurer
Phone # (785) 843-4551

Banks or Depositories

Intrust Bank
901 Vermont
Lawrence, Kansas 66044

Signed: James Tice Clark
Date Signed: 02/20/2013

(End FEC FORM 1)

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