FEC Form 1 for BRENT WALTZ FOR CONGRESSForm 1 for BRENT WALTZ FOR CONGRESS

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1132445

1. BRENT WALTZ FOR CONGRESS

1527 Ashwood Ct.
GREENWOOD, IN 46143

NOTE: Address is different than previously reported

Email: BWALTZ@INDY.NET

2. Date: 12/08/2016

3. FEC Committee ID #: C00582676 This committee is a Principal Campaign Committee. Candidate: Mr. Brent Darryl Waltz
Party: Republican Party
Office Sought: House of Representatives
State is Indiana in District: 09

Affiliated Committees/Organizations

NONE
, ____

Custodian of Records:

Mr. Mark Steven Collins
8411 Lismore Dr Apt. A
Indianapolis, IN 46227
Title: Treasurer
Phone # (317) 702-7295

Treasurer:

Mr. Mark Steven Collins
8411 Lismore Dr Apt. A
Indianapolis, Indiana 46227
Title: Treasurer
Phone # (317) 702-7295

Designated Agent(s):

Mr. Brent Darryl Waltz
1527 Ashwood Ct
Greenwood, Indiana 46143
Title: Candidate
Phone # (317) 435-0195

Banks or Depositories

Huntington Bank
611 W. County line Road
Greenwood, Indiana 46142

Signed: Mr. Mark Steven Collins
Date Signed: 12/08/2016

(End FEC FORM 1)

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