FEC Form 1 for TEA PARTY FORWARDForm 1 for TEA PARTY FORWARD

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1057214

1. TEA PARTY FORWARD

211 N UNION STREET
SUITE 100
ALEXANDRIA, VA 22314
Email: dbacker@dbcapitolstrategies.com;csirois@dbcapitolstrategies.com

NOTE: Email address is different than previously reported

2. Date: 03/24/2016

3. FEC Committee ID #: C00608166

This committee supports/opposes more than one Federal candidate and is NOT a separate segregated fund or a party committee.

Affiliated Committees/Organizations

Committee ID# C00520825
THE TEA PARTY LEADERSHIP FUND
203 S. UNION ST.
SUITE 300
ALEXANDRIA, Virginia 22314
Affiliated Relationship Code: Affiliated Committee

Custodian of Records:

Christina Sirois
203 S Union St
Ste 300
Alexandria, VA 22314
Title: Assistant Treasurer
Phone # (571) 882-9731

Treasurer:

Dan Backer
203 S Union St
Ste 300
Alexandria, Virginia 22314
Title: Treasurer
Phone # (202) 210-5431

Designated Agent(s):

Christina Sirois
203 S Union St
Ste 300
Alexandria, Virginia 22314
Title: Assistant Treasurer
Phone # (571) 882-9731

Banks or Depositories

Access National Bank
1800 Robert Fulton Drive
Reston, Virginia 20191

Signed: Dan Backer
Date Signed: 03/24/2016
Official Committee URL: www.teapartyforward.com

FORM TEXT-1

(End FEC FORM 1)

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