FEC Form 1 for Congressman Waxman Campaign CommitteeForm 1 for Congressman Waxman Campaign Committee

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-765310

1. Congressman Waxman Campaign Committee

6380 Wilshire Blvd., #1612
Los Angeles, CA 90048
Email: jane20@pacbell.net

NOTE: Email address is different than previously reported

2. Date: 02/10/2012

3. FEC Committee ID #: C00013128 This committee is a Principal Campaign Committee. Candidate: Henry A Waxman
Party: Democratic Party
Office Sought: House of Representatives
State is California in District: 33

Affiliated Committees/Organizations

LA PAC
6380 Wilshire Blvd # 1612
Los Angeles, California 90048
Affiliated Relationship Code: Leadership PAC Sponsor

Custodian of Records:

Mary Ellen Padilla
6380 Wilshire Blvd. Suite 1612
Los Angeles, CA 90048
Title: Assistant Treasurer
Phone # (323) 655-4065

Treasurer:

Mary Ellen Padilla
6380 Wilshire Blvd. Suite 1612
Los Angeles, California 90048
Title: Treasurer
Phone # (323) 655-4065

Designated Agent(s):

Jane Leiderman
6380 Wilshire Blvd. Suite 1612
Los Angeles, California 90048
Title: Assistant Treasurer
Phone # (323) 655-4065

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-765310

1. Congressman Waxman Campaign Committee

NOTE: Email address is different than previously reported

2. Date: 02/10/2012

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: Mary Ellen Padilla
Date Signed: 02/10/2012

(End FEC FORM 1)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-765310

1. Congressman Waxman Campaign Committee

NOTE: Email address is different than previously reported

2. Date: 02/10/2012

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: Mary Ellen Padilla Date Signed: 02/10/2012

(End FEC FORM 1)

Signed: Mary Ellen Padilla
Date Signed: 02/10/2012