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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-797334

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1. Kelly PAC

    901 N Washington Street
    Suite 700
    Alexandria, VA 223141535

    NOTE: Address is different than previously reported

    Email: ted@kochandhoos.com

2. Date: 07/14/2012

3. FEC Committee ID #: C00493411

This committee supports/opposes more than one Federal candidate and is NOT a separate segregated fund or a party committee.
     In addition, this committee is a Leadership PAC.

Affiliated Committees/Organizations

Kelly A. Ayotte
P.O. Box 937
Manchester, New Hampshire 031050937
Affiliated Relationship Code: Leadership PAC Sponsor

Custodian of Records:

Theodore V. Koch
901 N Washington Street
Suite 700
Alexandria, VA 223141535
Title: Treasurer
Phone # (703) 299-8570

Treasurer:

Theodore V. Koch
901 N Washington Street
Suite 700
Alexandria, Virginia 223141535
Title: Treasurer
Phone # (703) 299-8570

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

Bank of America
600 N Washington Street
Alexandria, Virginia 22314

Signed: Theodore V. Koch
Date Signed: 07/14/2012

(End FEC FORM 1)

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