FEC Form 2 for Report FEC-772532FEC Form 2 for Report FEC-772532

FEC FORM 2

STATEMENT OF CANDIDACY

FILING FEC-772532

1. David N Cicilline

702 Elmgrove Ave
Providence, RI 02906

2. Identification Number: H0RI01073

3. Party: Democratic Party

4. Office Sought: House of Representatives

5-6. State & District of Candidate: Rhode Island - 1

DESIGNATION OF PRINCIPAL CAMPAIGN COMMITTEE

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

The Cicilline Committee
FEC ID #: C00476564

236 Hope Street
Providence, RI 02906

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.

Jared Polis Victory Fund 2012
FEC ID #: C00501825

PO Box 1174
Springfield, VA 22151

Rhode Island Victory
FEC ID #: C00490169

118 N Main St
SUITE 2
PROVIDENCE, RI 02903

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: David N Cicilline
Signed by the candidate on: 03/28/2012

Filed: 03/28/2012

(End FEC FORM 2)

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