STATEMENT OF ORGANIZATION

Transcription

1 Image# FE FORM 1 1. NAME OF OMMITTEE (in full) MENT OF ORGANIZATION (heck if name Montana Democratic Party Example: If typing, type over the lines. 12FE4M5 Office Use Only 03/13/ : 42 PAGE 1 / 5 ADDRESS (number and street) PO Box 802 Helena MT ITY ZIP ODE OMMITTEE'S ADDRESS holly@campaigncompliance.net Optional Second Address OMMITTEE'S WEB PAGE ADDRESS (URL) 2. DATE M M / D D / Y Y Y Y FE IDENTIFIATION NUMBER IS THIS MENT NEW (N) OR AMENDED (A) I certify that I have examined this Statement and to the best of my knowledge and belief it is true, correct and complete. Type or Print Name of Treasurer Signature of Treasurer M M / D D / Y Y Y Y [Electronically Filed] Date NOTE: Submission of false, erroneous, or incomplete information may subject the person signing this Statement to the penalties of 2 U.S.. 437g. ANY HANGE IN INFORMATION SHOULD BE REPORTED WITHIN 10 DAYS. Office Use Only For further information contact: Federal Election ommission Toll Free Local FE FORM 1 (Revised 06/2012)

2 Image# FE Form 1 (Revised 02/2009) Page 2 5. TYPE OF OMMITTEE andidate ommittee: (a) (b) Name of andidate This committee is a principal campaign committee. (omplete the candidate information below.) This committee is an authorized committee, and is NOT a principal campaign committee. (omplete the candidate information below.) andidate Party Affiliation Office Sought: House Senate President State District (c) This committee supports/opposes only one candidate, and is NOT an authorized committee. Name of andidate Party ommittee: (National, State (d) This committee is a STA or subordinate) committee of the DEM (Democratic, Republican, etc.) Party. Political Action ommittee (PA): (e) This committee is a separate segregated fund. (Identify connected organization on line 6.) Its connected organization is a: orporation orporation w/o apital Stock Labor Organization Membership Organization Trade Association ooperative In addition, this committee is a Lobbyist/Registrant PA. (f) This committee supports/opposes more than one Federal candidate, and is NOT a separate segregated fund or party committee. (i.e., nonconnected committee) In addition, this committee is a Lobbyist/Registrant PA. In addition, this committee is a Leadership PA. (Identify sponsor on line 6.) Joint Fundraising Representative: (g) (h) This committee collects contributions, pays fundraising expenses and disburses net proceeds for two or more political committees/organizations, at least one of which is an authorized committee of a federal candidate. This committee collects contributions, pays fundraising expenses and disburses net proceeds for two or more political committees/organizations, none of which is an authorized committee of a federal candidate. ommittees Participating in Joint Fundraiser FE ID number FE ID number FE ID number FE ID number

3 Image# FE Form 1 (Revised 02/2009) Page 3 Write or Type ommittee Name Montana Democratic Party 6. Name of Any onnected Organization, Affiliated ommittee, Joint Fundraising Representative, or Leadership PA Sponsor Tester Victory Fund 3242 ummins Way Missoula MT ITY ZIP ODE Relationship: onnected Organization Affiliated ommittee Joint Fundraising Representative Leadership PA Sponsor 7. ustodian of Records: Identify by name, address (phone number -- optional) and position of the person in possession of committee books and records. Giarraputo, Holly,,, 3242 ummins Way Missoula MT ITY ZIP ODE 8. Treasurer: List the name and address (phone number -- optional) of the treasurer of the committee; and the name and address of any designated agent (e.g., assistant treasurer). of Treasurer PO Box 802 omptroller Helena MT ITY ZIP ODE Treasurer

4 Image# FE Form 1 (Revised 02/2009) Page 4 of Designated Agent ITY ZIP ODE 9. Banks or Other Depositories: List all banks or other depositories in which the committee deposits funds, holds accounts, rents safety deposit boxes or maintains funds. First Interstate Bank 3502 Brooks Missoula MT ITY ZIP ODE ity National Bank 400 N. Roxbury Drive Beverly Hills A ITY ZIP ODE

5 Image# FORM 1S -MENT OF ORGANIZATION (Supplemental Page) FE Form 1 (Revised 06/2011) Page 5 Banks or Other Depositories: List all banks or other depositories in which the committee deposits funds, holds accounts, rents safety deposit boxes or maintains funds. Amalgamated Bank 1825 K St., NW Washington D ITY ZIP ODE Name of Any onnected Organization, Affiliated ommittee, Joint Fundraising Representative, or Leadership PA Sponsor DN State Party Victory Fund 430 S. apitol St., SE Washington D ITY.. ZIP ODE. Relationship: onnected Organization Affiliated ommittee Joint Fundraising Representative Leadership PA Sponsor Designated Agent. ITY.. ZIP ODE. Joint Fundraiser Participant FE ID number