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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1498201

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1. Mother on a Mission (Mom PAC)

    NOTE:Commmittee Name is different than previously reported

    885 Woodstock Rd
    Suite 430-528
    Roswell, GA 30075
    Email: lora@bluewavepolitics.com;ksderby@gmail.com

2. Date: 02/02/2021

3. FEC Committee ID #: C00691352

This 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)

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