FORM 1 STATEMENT OF ORGANZATON RECEVED MW CEHTER Office Use Onl^ 1. NAME OF COMfVTTEE (in full) (Check if name is changed) over ine lines. lw»>araassiwib^!wmwa^^^ Pawlenty for President Exploratory Committee! M r j 1 l i l l l i l l One Financial Plaza, ADDRESS (number and street) j- _ 120 South Sixth Street, 9th Floor! ["11 (Check if address. i-^l s changed) [ Mir^neayolis MN 55402 CTY STATE ZP CODE COMMTTEE'S E-MA ADDRESS (Please provide only one e-mail address) info@timpawlenty.com (Check if address ^ i! T! ^1 i i i kl is changed)! COMMTTEE'S WEB PAGE ADDRESS (UR) y (Check if address is changed) www.t:irnpawlentjy, com i i i 2. DATE 03 18 j 2011 1 3. DENTFCATON NUMBER 4. is THS STATEMENT ix NEW (N) OR j AMENDED (A) / certify that 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 Mark Kennedy Signature of Treasurer Date 03! 18 ' 2011 _ NOTE: Submission of false, erroneous, or incomplete information may subject the person signing this Statement to the penalties of 2 U.S.C. 437g. ANY CHANGE N NFORMATON SHOUD BE REPORTED WTHN 10 DAYS. Office Use Only For further nformation contact: Federal Election Commission Toll Free 800-424-9530 ocal 202-694-1100 FORM 1 (Revised 02/2009)
Form 1 (Revised 02/2009) Page 2 5. TYPE OF COMMTTEE Committee: (a) ^X; ' This committee is a principal campaign committee. (Complete the candidate information below.) (b) Name of This committee is an authorized committee, and is NOT a principal campaign committee. (Complete the candidate information below.) Timothy Pawlenty i i i Sa:5i3:i ;..-:H:' Party Affiliation Office Sought: House j Senate President state District (c) [[ This committee supports/opposes only one candidate, and is NOT an authorized committee. Name of l i l l l i l l 1 i Party Committee: (d) committee is a Political Action Committee (PAC): (National, State or subordinate) committee of the (Democratic, Republican, etc.) Party. (e) This committee is a separate segregated fund. (dentify connected organization on line 6.) ts connected organization is a: Corporation 1^ Corporation w/o Capital Stock abor Organization Membership Organization 1^ Trade Association Cooperative 1^ n addition, this committee is a obbyist/registrant PAC. (0 P This committee supports/opposes more than one Federal candidate, and is NOT a separate segregated fund or party committee, (i.e., nonconnected committee) jj n addition, this committee is a obbyist/registrant PAC. ijl n addition, this committee is a eadership PAC. (dentify sponsor on line 6.) oint Fundraising Representative: (g) 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. (h) [f^ 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. Committees Participating in oint Fundraiser 1.! i M 2. 3. 4. D number Qp D number QM D number 10 j D number 10^
Form 1 (Revised 02/2009) Page 3 Write or Type Committee Name 6. Name of Any Connected Organization, Affiliated Committee, oint Fundraising Representative, or eadership PAC Sponsor CTY STATE l"l ZP CODE Relationship: Connected Organization?^ Affiliated Committee ^ oint Fundraising Representative j eadership PAC Sponsor 7. Custodian of Records: dentify by name, address (phone number -- optional) and position of the person in possession of committee books and records. Full Name Gregg Peterson 1^^ l l l l l l l l l l l M in nejai^o:^ S -_ Title or Position CTY STATE ZP CODE ^s^i^t^ntp yreapupr^r Telephone number i i i -1 i i ~ 8. Treasurer: ist 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). Full Name ^^^^ Kennedy of Treasurer i i i i i i i i i i qn^?i?aipcfa^ pi,a2^a,, 2^2(f ^optfi,s^xt^h,st^r^e^,, 9y:h, F.lqoi^,,,, N inn^ayojip 11 11 m i^i^w i-i, Title or Position Treasurer l l l l l l l l l Telephone number i i -1 i i ~ i i i
Form 1 (Revised 02/2009) Page 4 n Full Name of Designated Agent i r D i- ^F^^^ t et^eips9n i i i i i i i i qnq ^ii^ai^cia;! pi,a2;a,, 1^2? ^opt)i ^:^xt^h,st^r^e^,, 9 :h, F,lqoi^, i i i i ' ^^ir^n^ago;i^ 5,5402, -.,, 0? Title or Position Aps,i^t^ntp l-r^apuprepr,,,,,,,,, Telephone number i i -1 i i -1. qr]! 9. Banks or Other Depositories: ist all banks or other depositories in which the committee deposits funds, holds accounts, rents safety deposit boxes or maintains funds. Name of Bank, Depository, etc. Wells Fargo Bank ' ' l l "^190,0 i^^ryep fiv,en,u^ ^o^tl^ ' l l Blc^oiningtpo^ M 55431, -,,, Name of Bank, Depository, etc. BB&T ^.Oq ^oytl^ ^aph^r^gt^or^ ^tye^t l l l l l l l l l Alexandria i VA 22314 i i T T l-l
Federal Election Commission ENVEOPE REPACEMENT PAGE FOR NCOMNG DOCUMENTS The added this page to the end of this filing to indicate how it was received. Hand Delivered USPS First Class Mail USPS Registered/Certified USPS Priority Mail s/zi/it (R/C) Delivery Confirmation or Signature Confirmation abel USPS Express Mail Postmark llegible No Postmark Overnight Delivery Service (Specify): Shipping Date Next Business Day Delivery Received from House Records & Registration Office Received from Senate Public Records Office Received from Electronic Filing Office Other (Specify): or 0^ PREPARER (3/2005) 3/zf/l/ DATE PREPARED