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FEC FORM 2

STATEMENT OF CANDIDACY

FILING FEC-756085

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1. Ann Marie Buerkle

3779 Underwood Way
Syracuse, NY 132156600

2. Identification Number: H0NY25078

3. Party: Republican Party

4. Office Sought: House of Representatives

5-6. State & District of Candidate: New York - 25

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DESIGNATION OF PRINCIPAL CAMPAIGN COMMITTEE

7. I hereby designate the following named political committee as my Principal Campaign Committee for the 2012 election(s).

    Ann Marie Buerkle for Congress
    FEC ID #: C00473751

    PO Box 219
    Syracuse, NY 132140219

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DESIGNATION OF OTHER AUTHORIZED COMMITTEES

8. I hereby designate the following named committee, which is NOT my principal campaign committee, to receive and expend funds on behalf of my candidacy.

    New York Congressional Victory Committee 2011
    FEC ID #: C00503326

    228 S Washington Street
    Suite 115
    Alexandria, VA 223145404

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DECLARATION OF INTENT TO EXPEND PERSONAL FUNDS (House or Senate Only)

9. I intend to expend personal funds exceeding the threshold amount (see 11 C.F.R. 400.9) by

    9A. 0.00 for the primary election, and
    9B. 0.00 for the general election

Signed as: Ann Marie Buerkle
Signed by the candidate on: 12/30/2011

Filed: 12/30/2011

(End FEC FORM 2)

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