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

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-876583

1. SOUTHERLAND FOR CONGRESS

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

2. Date: 07/10/2013

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

Committee ID# C00543975
PATRIOT DAY I
228 S WASHINGTON ST STE 115
ALEXANDRIA, Virginia 22314
Affiliated Relationship Code: Joint Fundraising Representative

Custodian of Records:

J. Carey Scott
P.O. Box 1692
Lynn Haven, FL 32444
Title: Treasurer
Phone # (850) 866-2440

Treasurer:

J. Carey Scott
P.O. Box 1692
Lynn Haven, Florida 32444
Title: Treasurer
Phone # (850) 866-2440

Designated Agent(s):

Derrick G. 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

BB&T
1909 K Street NW
Washington, DC 20006

Signed: J. Carey Scott
Date Signed: 07/10/2013
Official Committee URL: www.southerlandforcongress.com

(End FEC FORM 1)

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