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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-801009

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1. Friends of Nan Hayworth

    P.O. Box 188
    Carmel, NY 10512
    Email: kevin@bsbsolutions.net

    NOTE: Email address is different than previously reported

2. Date: 02/08/2012

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# C00506824
Freshman Class JFC
228 S. Washington St.
Ste. 115
Alexandria, Virginia 22314
Affiliated Relationship Code: Joint Fundraising Representative

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

Committee ID# C00519744
Patriot Day IV
228 S. Washington Street Ste. 115
Alexandria, Virginia 22314
Affiliated Relationship Code: Joint Fundraising Representative

Committee ID# C00523985
Freshman Hold'em JFC
209 Pennsylvania St. SE Ste 2109
Washington, DC 20003
Affiliated Relationship Code: Joint Fundraising Representative

Custodian of Records:

Kevin Jahns
BSB Solutions
3538 S. Wakefield St.
Arlington, VA 22206
Title: Treasurer
Phone # (703) 798-1802

Treasurer:

Kevin Jahns
BSB Solutions
3538 S. Wakefield St.
Arlington, Virginia 22206
Title: Treasurer
Phone # (703) 798-1802

Designated Agent(s):

Banks or Depositories

Wells Fargo Bank
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 NW
Washington, DC 20006


Access National Bank
1800 Robert Fulton Dr.
Reston, Virginia 20191

Signed: Kevin Jahns
Date Signed: 07/19/2012
Official Committee URL: www.nanhayworth.com

(End FEC FORM 1)

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