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FEC FORM 2

STATEMENT OF CANDIDACY

FILING FEC-799956

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1. Nan Hayworth

PO Box 188
Carmel, NY 10512

2. Identification Number: H0NY19139

3. Party: Republican Party

4. Office Sought: House of Representatives

5-6. State & District of Candidate: New York - 18

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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

    PO Box 188
    Carmel, NY 10512

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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.

    Team 2012
    FEC ID #: C00493817

    228 S. Washington St.
    Ste. 115
    Alexandria, VA 22314

    New York Congrssional Victory Committee 2011
    FEC ID #: C00503326

    228 S. Washington Street
    Ste. 115
    Alexandria, VA 22314

    Freshman Class JFC
    FEC ID #: C00506824

    228 S. Washington St.
    Ste. 115
    Alexandria, VA 22314

    Patriot Day IV
    FEC ID #: C00519744

    228 S. Washington Street Ste. 115
    Alexandria, VA 22314

    Freshman Hold'em JFC
    FEC ID #: C00523985

    209 Pennsylvania Ave. SE Ste 2109
    Washington, DC 20003

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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, and
    9B. 0.00 for the general election

Signed as: Nan Hayworth
Signed by the candidate on: 07/19/2012

Filed: 07/19/2012

(End FEC FORM 2)

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