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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1605181

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1. Friends of Doc Chai

    144 Blue Hills Road
    North Haven, CT 06473
    Email: amy.f.chai@gmail.com

2. Date: 07/26/2021

3. FEC Committee ID #: C00785634 This committee is a Principal Campaign Committee. Candidate: Dr Amy Fogelstrom Chai, MD
Party: Libertarian
Office Sought: House of Representatives
State is Connecticut in District: 03

Affiliated Committees/Organizations

Committee ID# C00785634
FRIENDS OF DOC CHAI
144 BLUE HILLS ROAD
NORTH HAVEN, Connecticut 06473
Affiliated Relationship Code: Joint Fundraising Representative

Custodian of Records:

Jon De Los Santos
5 Judd Avenue
Bethel, CT 06801
Title: Treasurer
Phone # (475) 218-9895

Treasurer:

Jon De Los Santos
5 Judd Avenue
Bethel, Connecticut 06801
Title: Treasurer
Phone # (475) 218-9895

Designated Agent(s):

Banks or Depositories

People's United Bank
2331 Dixwell Avenue
Hamden, Connecticut 06514

People's United Bank
293 Greenwood Avenue
Bethel, Connecticut 06801

Signed: Jon De Los Santos
Date Signed: 06/23/2022
Official Committee URL: docchai2022.com

(End FEC FORM 1)

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