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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-523040

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1. Blaine for Congress 2012

    PO Box 1526
    Columbia, MO 65205
    Email: info@blaineforcongress

2. Date: 12/07/2010

3. FEC Committee ID #: C00458679

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

Affiliated Committees/Organizations

Committee ID# C00447748
Blaine for Congress 2008
PO Box 1526
Columbia, Missouri 65205
Affiliated Relationship Code: Affiliated Committee

Committee ID# C00454983
Luetkemeyer Victory Committee
729 Main Street
St. Elizabeth, Missouri 65075
Affiliated Relationship Code: Affiliated Committee

Custodian of Records:

Brice A. Luetkemeyer
PO Box 96
St. Elizabeth, MO 65075
Title: Treasurer
Phone # (573) 493-2313

Treasurer:

Brice A. Luetkemeyer
PO Box 96
St. Elizabeth, Missouri 65075
Title: Treasurer
Phone # (573) 493-2313

Designated Agent(s):

Banks or Depositories

Bank of St. Elizabeth
PO Box 96
St. Elizabeth, Missouri 65075

TD Bank
810 West Diamond Avenue
Gaithersburg, Maryland 20878

Signed: Brice A. Luetkemeyer
Date Signed: 01/01/2009
Official Committee URL: www.blaineforcongress.com

(End FEC FORM 1)

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