FEC Form 1 for COFFMAN FOR CONGRESS 2012Form 1 for COFFMAN FOR CONGRESS 2012

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-768618

1. COFFMAN FOR CONGRESS 2012

9249 SOUTH BROADWAY #200-501
HIGHLANDS RANCH, CO 80129
Email: paul@pdscompliance.com

NOTE: Email address is different than previously reported

2. Date: 03/01/2012

3. FEC Committee ID #: C00497180 This committee is a Principal Campaign Committee. Candidate: Michael Coffman
Party: Republican Party
Office Sought: House of Representatives
State is Colorado in District: 06

Affiliated Committees/Organizations

NONE
, ____

Custodian of Records:

Paul Kilgore
2470 Daniells Bridge Rd Ste 121
Athens, GA 30606
Title: Custodian of Records
Phone # (706) 534-7780

Treasurer:

Florine Nath
9249 South Broadway #200-501
Highlands Ranch, Colorado 80129
Title: Treasurer
Phone # (303) 791-6453

Designated Agent(s):

Paul Kilgore
2470 Daniells Bridge Rd Ste 121
Athens, Georgia 30606
Title: Assistant Treasurer
Phone # (706) 534-7780

Banks or Depositories

AMG National Trust Bank
6501 East Belleview Ave Ste 400
Englewood, Colorado 80111

Signed: Florine Nath
Date Signed: 03/01/2012
Official Committee URL: www.coffmanforcongress.com

(End FEC FORM 1)

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