FEC Form 2 for Report FEC-811654FEC Form 2 for Report FEC-811654

FEC FORM 2

STATEMENT OF CANDIDACY

FILING FEC-811654

1. Jackie Walorski

59555 County Road 3
Elkhart, IN 46517

2. Identification Number: H0IN02190

3. Party: Republican Party

4. Office Sought: House of Representatives

5-6. State & District of Candidate: Indiana - 2

DESIGNATION OF PRINCIPAL CAMPAIGN COMMITTEE

7. I hereby designate the following named political committee as my Principal Campaign Committee for the 2012 election(s).

Walorski for Congress Inc.
FEC ID #: C00468579

PO Box 954
Mishawaka, IN 465460954

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.

Young Guns 2012 Round 1
FEC ID #: C00521294

228 S Washington St
Ste 115
Alexandria, VA 22314

Hickory Hoosier JFC
FEC ID #: C00529644

47 S Meridian St
Suite 200
Indianapolis, IN 46204

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: Jackie Walorski
Signed by the candidate on: 09/24/2012

Filed: 09/24/2012

(End FEC FORM 2)

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