FEC FORM 2
STATEMENT OF CANDIDACY
FILING FEC-716024
1. Nan Hayworth
NOTE: Address is different than previously reported
P. O. Box 188Carmel, NY 10512
2. Identification Number: H0NY19139
3. Party: Republican Party
4. Office Sought: House of Representatives
5-6. State & District of Candidate: New York - 19
DESIGNATION OF PRINCIPAL CAMPAIGN COMMITTEE
7. I hereby designate the following named political committee as my Principal Campaign Committee for the 2012 election(s).
Friends of Nan Hayworth
FEC ID #: C00466490
P. O. Box 188Carmel, NY 10512
DESIGNATION OF OTHER AUTHORIZED COMMITTEES
8. I hereby designate the following named committee, which is NOT my principal campaign committee, to receive and expend funds on behalf of my candidacy.
NY-19 Congressional Victory Committee
FEC ID #: C00470526
264 N. Lumpkin Street, #202Athens, GA 30601
New York House Victory Fund
FEC ID #: C00487637
228 S. Washington Street, #115Alexandria, VA 22314
DECLARATION OF INTENT TO EXPEND PERSONAL FUNDS (House or Senate Only)
9. I intend to expend personal funds exceeding the threshold amount (see 11 C.F.R. 400.9) by
9A. 0.00 for the primary election, and9B. 0.00 for the general election