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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1536421

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1. Sam for Senate

    61520 Marysville Lane
    John Day, OR 97845
    Email: sam4senate2022@gmail.com;loripiercy@centurylink.net

2. Date: 08/26/2021

3. FEC Committee ID #: C00788000 This committee is a Principal Campaign Committee. Candidate: Samuel Palmer
Party: Republican Party
Office Sought: Senate
State is Oregon in District: 00

Affiliated Committees/Organizations

NONE
, ____

Custodian of Records:

Ms. Pennie Peasley
513 Hwy 20 N
Hines, OR 97738
Title: Treasurer
Phone # (541) 589-2500

Treasurer:

Ms. Pennie Peasley
513 Hwy 20 N
Hines, Oregon 97738
Title: Treasurer
Phone # (541) 589-2500

Designated Agent(s):

Lori Piercy
29993 Maple Drive
Rainier, Oregon 97048
Title: Assistant Treasurer
Phone # (503) 816-7131

Banks or Depositories

Old West FCU
650 West Main
John Day, Oregon 97845

Signed: Ms. Pennie Peasley
Date Signed: 08/26/2021

(End FEC FORM 1)

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