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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1140934

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1. Collins for Congress

    PO Box 1295
    Gainesville, GA 30503
    Email: paul@pdscompliance.com;mgoode@pdscompliance.com

    NOTE: Email address is different than previously reported

2. Date: 01/24/2017

3. FEC Committee ID #: C00502039 This committee is a Principal Campaign Committee. Candidate: Doug Collins
Party: Republican Party
Office Sought: House of Representatives
State is Georgia in District: 09

Affiliated Committees/Organizations

Committee ID# C00631663
Collins Leadership Fund
824 S, Milledge Ave. Ste. 101
Athens, Georgia 30605
Affiliated Relationship Code: Joint Fundraising Representative

Custodian of Records:

Treasurer:

Carroll Brian Daniel
PO Box 1438
Gainesville, Georgia 305031438
Title: Treasurer
Phone # (770) 536-3241

Designated Agent(s):

Banks or Depositories

Chattahoochee Bank of Georgia
643 EE Butler Parkway
Gainesville, Georgia 30501

Wells Fargo
400 Montgomery St
San Francisco, California 94104

Signed: Carroll Brian Daniel
Date Signed: 01/24/2017
Official Committee URL: www.collinsleads.com

(End FEC FORM 1)

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