FEC Form 1 for SOUTHERLAND FOR CONGRESSForm 1 for SOUTHERLAND FOR CONGRESS

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-522721

1. SOUTHERLAND FOR CONGRESS

PO BOX 1692
LYNN HAVEN, FL 32444
Email: steve@southerlandforcongress.com

2. Date: 12/03/2010

3. FEC Committee ID #: C00468959 This committee is a Principal Campaign Committee. Candidate: WILLIAM STEVE SOUTHERLAND, II
Party: Republican Party
Office Sought: House of Representatives
State is Florida in District: 02

Affiliated Committees/Organizations

NONE
, ____

Custodian of Records:

Greg M. Brudnicki
P.O. Box 1692
Lynn Haven, FL 32444
Title: Treasurer
Phone # (850) 769-6141

Treasurer:

Greg M. Brudnicki
P.O. Box 1692
Lynn Haven, Florida 32444
Title: Treasurer
Phone # (850) 769-6141

Designated Agent(s):

Derrick Bennett
P.O. Box 1692
Lynn Haven, Florida 32444
Title: Assistant Treasurer
Phone # (850) 866-2440

Banks or Depositories

BankTrust
2315 Highway 77
Lynn Haven, Florida 32444

Signed: Greg M. Brudnicki
Date Signed: 12/03/2010
Official Committee URL: www.southerlandforcongress.com

(End FEC FORM 1)

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