FEC Form 1 for GRASS ROOTS INITIATIVE TO MAINTAIN OUR MAJORITY POLITICAL ACTION COMMITTEE A/K/A/GRIMM PACForm 1 for GRASS ROOTS INITIATIVE TO MAINTAIN OUR MAJORITY POLITICAL ACTION COMMITTEE A/K/A/GRIMM PAC

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-816923

1. GRASS ROOTS INITIATIVE TO MAINTAIN OUR MAJORITY POLITICAL ACTION COMMITTEE A/K/A/GRIMM PAC

PO BOX 2485
SPRINGFIELD, VA 22152
Email: grimmpac@concentricoffice.com

2. Date: 10/15/2012

3. FEC Committee ID #: C00497677

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

Candidate ID# H0NY13074
MICHAEL GRIMM
560 9TH STREET
BROOKLYN, New York 11215
Affiliated Relationship Code: Leadership PAC Sponsor

Custodian of Records:

Robert F. Carlin
P.O. Box 2485
Sprinfield, VA 22152
Title: Treasurer
Phone # (703) 569-9400

Treasurer:

Robert F. Carlin
P.O. Box 2485
Sprinfield, Virginia 22152
Title: Treasurer
Phone # (703) 569-9400

Designated Agent(s):

Banks or Depositories

BB&T
1909 K Street, NW
Washington, DC 200061152

Chase Bank
1581 Route 202
Pomona, New York 10970

Signed: Robert F. Carlin
Date Signed: 10/15/2012

(End FEC FORM 1)

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