RCIE E EV D

FEC FORM 2
S A EM N OF CANDIDACY TTI ET
1. (a) Name of Candidate (in full) (b) Address (number and street) (c) City, State, and ZIP Code 4. Party Affiiiafiori 5. Offlbe Sought bcheck if address changed

21 MY IT A 8'39 01 A M FEC M I C M E AL E T R

2. Candidate's FEC Identification Number 3. Is This Statement 6. State & District of Candidate .-j/Wew V T (N) r Amended / J i (A)

OR

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a S. HOUSE

MISSOURI

t>lSTRlCT

DESIGNATION OF PRINCIPAL CAMPAIGN COMMITTEE

7. i hereby designatettiefollowing named political oommittee as my Principal Campaign Committee for the NOTE: This designation should be filed with the appropriate office listed in the instructions. (a) Name of Committee (in full) / ^ election(s). (year of election)

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(b) Address (number and street) (c) City, State, ancl ZIP Code

DESIGNATION OF OTHER AUTHORIZED COMMITTEES

(Including Joint Fundraising Representatives) 8. I hereby autiiorize the following named committee, which is NOT my principal campaign committee, to receive and expend funds on behalf of my . candidacy ... _ , NOTE: Tills designation should be filed with the principal campaign committee. (a) NameofGommittee-(infull) -

(b) Address (number and street)

(c) City, State, and ZIP Code

/ certify that I have examined thia Statement and to the best of my knowledge and belief it is true, correct and complete.

FEC FORM 2 (REV. 02/2009)

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 y USPS First Class Mail Postmarked (R/C) USPS Registered/Certified Postmarked USPS Priority Mail Delivery Confirmation or Signature Confirmation Label | Postmarked USPS Express Mail

Postmark Illegible

No Postmark Shipping Date Overnight Delivery Service (Specify): Next Business Day Delivery 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 I I Other (Specify):

PREPARER (3/2005)

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DATE PREPARED