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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1099838

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1. Reform Wisconsin Fund

    N4298 12 Corners Road
    Black Creek, WI 54106
    Email: lorri.pickens@reagan.com

2. Date: 09/19/2016

3. FEC Committee ID #: C00626150

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

Affiliated Committees/Organizations

NONE
, ____

Custodian of Records:

Lorri Pickens
N4298 12 Corners Road
Black Creek, WI 54106
Title: Treasurer

Treasurer:

Lorri Pickens
N4298 12 Corners Road
Black Creek, Wisconsin 54106
Title: Treasurer

Designated Agent(s):

Lorri Pickens
N4298 12 Corners Road
Black Creek, Wisconsin 54106
Title: Treasurer

Banks or Depositories

BMO Harris Bank NA
402 E. Wisconsin Avenue
Appleton, Wisconsin 54911

Signed: Lorri Pickens
Date Signed: 09/19/2016

FORM TEXT-1

(End FEC FORM 1)

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