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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-755072

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1. Civic Forum PAC

    P.O. Box 365
    McLean, VA 22101
    Email: melodie@complianceconsultingva.com

2. Date: 12/15/2011

3. FEC Committee ID #: C00461145

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:

Cabell Hobbs
P.O. Box 365
McLean, VA 22101
Title: Assistant Treasurer

Treasurer:

HOUSTON SANFORD
PO BOX 365
MCLEAN, Virginia 22101
Title: Treasurer

Designated Agent(s):

Cabell Hobbs
P.O. Box 365
McLean, Virginia 22101
Title: Assistant Treasurer

Banks or Depositories

BB&T
PO Box 200
Wilson, North Carolina 27894

Signed: HOUSTON SANFORD
Date Signed: 12/19/2011

(End FEC FORM 1)

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