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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-755735

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1. Friends of Nan Hayworth

    P. O. Box 188
    Carmel, NY 10512
    Email: nwatkins@robertwatkins.com

2. Date: 10/05/2011

3. FEC Committee ID #: C00466490 This committee is a Principal Campaign Committee. Candidate: Nan Hayworth
Party: Republican Party
Office Sought: House of Representatives
State is New York in District: 19

Affiliated Committees/Organizations

Committee ID# C00493817
Team 2012
228 S. Washington St., Ste. 115
Akexandria, Virginia 22314
Affiliated Relationship Code: Joint Fundraising Representative

Committee ID# C00503326
New York Congressional Victory Committ
228 S. Washington Street, Ste. 115
Alexandria, Virginia 22314
Affiliated Relationship Code: Joint Fundraising Representative

Custodian of Records:

Nancy H. Watkins
610 S. Boulevard
Tampa, FL 33606
Title: Treasurer
Phone # (813) 254-3369

Treasurer:

Nancy H. Watkins
610 S. Boulevard
Tampa, Florida 33606
Title: Treasurer
Phone # (813) 254-3369

Designated Agent(s):

Robert I. Watkins
610 S. Boulevard
Tampa, Florida 33606
Title: Assistant Treasurer
Phone # (813) 254-3369

Banks or Depositories

Wells Fargo Bank/Wachovia
195 N. Bedford Road
Mount Kisco, New York 10549

TD Bank
193 E. Main Street
Mount Kisco, New York 10549

BB&T
1909 K Street, N.W.
Washington, DC 20006

Signed: Nancy H. Watkins
Date Signed: 12/21/2011
Official Committee URL: www.nanhayworth.com

(End FEC FORM 1)

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