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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1011881

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1. Jim Jordan for Congress

    1709 State Route 560 South
    Urbana, OH 43078
    Email: jkordik@rogersgreenberg.com

2. Date: 06/30/2015

3. FEC Committee ID #: C00416594

This committee is an independent expenditure-only political committee (Super PAC).

Affiliated Committees/Organizations

Committee ID# C00573550
FREEDOMWORKS PAC
PO BOX 374
MCLEAN, Virginia 22101
Affiliated Relationship Code: Joint Fundraising Representative

Custodian of Records:

James G Kordik
2160 Kettering Tower
Dayton, OH 45423
Title: Treasurer
Phone # (937) 223-8171

Treasurer:

James G Kordik
2160 Kettering Tower
Dayton, Ohio 45423
Title: Treasurer
Phone # (937) 223-8171

Designated Agent(s):

Banks or Depositories

Key Bank
PO Box 22114
Albany, New York 12201

Security National Bank
PO Box 351
Urbana, Ohio 43078

Old Fort Banking Co.
8034 Main Street
Old Fort, Ohio 44861

Signed: James G Kordik
Date Signed: 06/30/2015
Official Committee URL: http://jimjordanforcongress.com/

(End FEC FORM 1)

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