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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-802732

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1. Kim Dolbow Vann for Congress

    PO Box 984
    Willows, CA 959880984
    Email: treasurerlawler@sbcglobal.net

2. Date: 08/02/2012

3. FEC Committee ID #: C00500900 This committee is a Principal Campaign Committee. Candidate: Kimberly Dolbow Vann
Party: Republican Party
Office Sought: House of Representatives
State is California in District: 03

Affiliated Committees/Organizations

Committee ID# C00524579
Replace Obamacare Democrats
2470 Daniels Bridge Road
Suite 121
Athens, Georgia 306066191
Affiliated Relationship Code: Joint Fundraising Representative

Committee ID# C00524835
CAL Victory Fund
PO Box 30844
Bethesda, Maryland 208240844
Affiliated Relationship Code: Joint Fundraising Representative

Committee ID# C00500900
Young Guns 2012 Round 2
228 S Washington Street
Suite 115
Alexandria, Virginia 223145404
Affiliated Relationship Code: Joint Fundraising Representative

Custodian of Records:

Kelly Lawler
PO Box 984
Willows, CA 959880984
Title: Treasurer
Phone # (530) 934-5823

Treasurer:

Kelly Lawler
PO Box 984
Willows, California 959880984
Title: Treasurer
Phone # (530) 934-5823

Designated Agent(s):

Banks or Depositories

Tri Counties Bank
210 N Tehama Street
Willows, California 959882834

Wells Fargo Bank
7901 Wisconsin Avenue
Bethesda, Maryland 208143619

SunTrust Bank
PO Box 4418
Atlanta, Georgia 303024418

Signed: Kelly Lawler
Date Signed: 08/02/2012

(End FEC FORM 1)

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