FEC Form 1 for Benishek for Congress, Inc.Form 1 for Benishek for Congress, Inc.

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-781635

1. Benishek for Congress, Inc.

PO Box 108
Gladstone, MI 498370108

NOTE: Address is different than previously reported

Email: tim@kochandhoos.com

2. Date: 05/03/2012

3. FEC Committee ID #: C00476325 This committee is a Principal Campaign Committee. Candidate: Daniel J. Benishek, MD
Party: Republican Party
Office Sought: House of Representatives
State is Michigan in District: 01

Affiliated Committees/Organizations

Committee ID# C00511519
Patriot Day III
228 S Washington Street
Suite 115
Alexandria, Virginia 223145404
Affiliated Relationship Code: Joint Fundraising Representative

Custodian of Records:

Timothy A. Koch
901 N Washington Street
Suite 700
Alexandria, VA 223141535
Title: Custodian of Records
Phone # (703) 299-8571

Treasurer:

Trent J. Benishek
PO Box 108
Gladstone, Michigan 498370108
Title: Treasurer
Phone # (202) 495-1757

Designated Agent(s):

Timothy A. Koch
901 N Washington Street
Suite 700
Alexandria, Virginia 223141535
Title: Assistant Treasurer
Phone # (703) 299-8571

Banks or Depositories

Chain Bridge Bank
1445A Laughlin Avenue
Mclean, Virginia 221015709

Wells Fargo
330 N Washington Street
Alexandria, Virginia 223142502

BB&T
1909 K Street NW
Washington, DC 200061152

Signed: Trent J. Benishek
Date Signed: 05/04/2012
Official Committee URL: www.benishekforcongress.com

(End FEC FORM 1)

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