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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-785734

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1. Civic Forum PAC

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

    NOTE: Email address is different than previously reported

2. Date: 05/20/2012

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
P.O. 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

Bank of America
100 N Tyron St
Charlotte, North Carolina 28255

Signed: Houston Sanford
Date Signed: 05/20/2012

(End FEC FORM 1)

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