FEC Form 1 for JUSTIN AMASH FOR CONGRESSForm 1 for JUSTIN AMASH FOR CONGRESS

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-815973

1. JUSTIN AMASH FOR CONGRESS

1500 E BELTLINE AVE SE STE 250
GRAND RAPIDS, MI 49506
Email: treasurer@justinamash.com

2. Date: 10/12/2012

3. FEC Committee ID #: C00476291 This committee is a Principal Campaign Committee. Candidate: JUSTIN AMASH
Party: Republican Party
Office Sought: House of Representatives
State is Michigan in District: 03

Affiliated Committees/Organizations

Committee ID# C00531574
MICHIGAN YOUNG GUNS VICTORY FUND (AMASH, BENISHEK, HUIZENGA, WALBERG)
25 E MAIN STREET
RICHMOND, Virginia 23219
Affiliated Relationship Code: Joint Fundraising Representative

Custodian of Records:

Mrs. Stacey Chalfoun
4700 Old Grand River Trail NE
Ada, MI 49301
Title: Treasurer
Phone # (616) 719-1935

Treasurer:

Mrs. Stacey Chalfoun
4700 Old Grand River Trail NE
Ada, Michigan 49301
Title: Treasurer
Phone # (616) 719-1935

Designated Agent(s):

Poppy Nelson
1500 E Beltline Ave SE
Ste 250
Grand Rapids, Michigan 49506
Title: Assistant Treasurer
Phone # (616) 719-1935

Banks or Depositories

Chemical Bank (FKA Byron Bank)
4024 Park East Court SE
Ste A
Grand Rapids, Michigan 49546

SunTrust Bank
919 E Main St

Richmond, Virginia 23219

Signed: Mrs. Stacey Chalfoun
Date Signed: 10/12/2012
Official Committee URL: www.amashforcongress.com

(End FEC FORM 1)

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