Hispanics For A Conservative America

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04/18/2808

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STATEMENT OF ORGANIZATION

FEC FORM1

(See instructions)

1.

NAME OF COMMITTEE (In 1ull)

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IS THIS STATEMENT

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i certify that I have examined this Statement ana to the best of my knowledge and belief it is true, correct and complete Type or Print Name of Treasurer

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NOTE: Submission of raise, erroneous, or incomplete Information may subject the person signing this Statement to we penalties of 2 U.S.C. S437g. ANY CHANGE IN INFORMATION SHOULD BE REPORTED WITHIN 10 DAYS

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For further information contact: Federal Election Commission

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FEO-ornM (Revised 02/2003)

Page 2

6. TYPE OF COMMITTEE (Check One) (a)

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(b)

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This committee is a principal campaign committee. (Complete the candidate information below.)

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Page3

FECFomH (Revised 02/2003)

Write or Type Committee Name HISPANICS FOR A CONSERVATIVE AMERICA 7.

Custodian of Records: Identify by name, address, (phone number - optional), and position of the person In possession of Committee books and records. SCOTT B MACKENZIE i i _i_ i i I i i i i

Full Name

1155 -1STH STREET, NW

Mailing Address

SUITE 410 WASHINGTON Title or Position V

CITY A

DC

20005

ZIP CODE A

STATEA

DEPUTY TREASURER

-

703

868

1778

Telephone number

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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).

Full Nome ofTreasurer

ALEXANDRIA CORONADO 1155-15TH STREET, NW

Mailing Address

SUITE 410 .

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CHAIRMAN / TREASURER

Full Name of Designated Agent

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20005 ZIP CODE A

STATE A

703

Telephone number

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SCOTT B MACKENZIE 11SS - 1STH STREET, NW

Mailing Address

SUITE 410 WASHINGTON Title or Position V

CITY A

DEPUTY TREASURER

20005 -

DC

STATE A

Telephone number

703

ZIP CODE A

868

1776

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FEC Form 1 (Revised 02/2003)

9.

04/04

Page 4

Banks or Other Oeposilorfas: List 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, ,

FIRST VIRGINIA COMMUNITY BANK I

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FE3AN042.POF

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15:47

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Federal Election Commission ENVELOPE REPLACEMENT PAGE FOR INCOMING DOCUMENTS The FEC added this page to the end of this filing to indicate how it was received. Date of Receipt Hand Delivered Postmarked USPS First Class Mail Postmarked (R/C) USPS Registered/Certified Postmarked USPS Priority Mail Delivery Confirmatkjn ™ Label Postmarked USPS Express Mail

Postmark Illegible

No Postmark Shipping Date Overnight Delivery Service (Specify): Date of Receipt Received from House Records & Registration Office Date of Receipt Received from Senate Public Records Office Date of Receipt Received from Electronic Filing Office Date of Receipt or Postmarked NX

Other (Specify):

The document preceding this page was received by FAX at the FEC. The receiving FAX machine has printed at the bottom of each page the date and time of receipt, the phone number of the transmitting machine and the sequential page numbers.

N/A PREPARER (5/2004)

N/A DATE PREPARED

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