FEC FORM 1
STATEMENT OF ORGANIZATION
FILING FEC-1498201
1. Mother on a Mission (Mom PAC)
NOTE:Commmittee Name is different than previously reported
885 Woodstock RdSuite 430-528
Roswell, GA 30075
Email: lora@bluewavepolitics.com;ksderby@gmail.com
2. Date: 02/02/2021
3. FEC Committee ID #: C00691352This committee supports/opposes more than one Federal candidate and is NOT a separate segregated fund or a party committee.
In addition, this committee is a Leadership PAC.
Affiliated Committees/Organizations
Candidate ID# H8GA06393
LUCIA KAY MS. MCBATH
885 Woodstock Road
Suite 430-528
Roswell, Georgia 30075
Affiliated Relationship Code: Leadership PAC Sponsor
Custodian of Records:
Lora Haggard
PO Box 699
Ringgold, GA 30736
Title: Asst. Treasurer
Phone # (423) 443-3308
Treasurer:
Kendra-Sue Derby
885 Woodstock Rd
Suite 430-528
Roswell, Georgia 30075
Title: Treasurer
Phone # (423) 443-3308
Designated Agent(s):
Lora Haggard
PO Box 699
Ringgold, Georgia 30736
Title: Asst. Treasurer
Phone # (423) 443-3308
Banks or Depositories
SunTrust
1120 Woodstock Rd
Roswell, Georgia 30075
Signed: Kendra-Sue Derby
Date Signed: 02/02/2021
(End FEC FORM 1)
Date Signed: 02/02/2021