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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-476554

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1. UNITED FOOD & COMMERCIAL WORKERS INTERNATIONAL UNION ACTIVE BALLOT CLUB

    1775 K STREET N.W.
    Washington, DC 20006
    Email: broberts@ufcw.org

2. Date: 06/28/2010

3. FEC Committee ID #: C00002766 This committee is a separate segregated fund. Its connected organization is a Labor Organization
     In addition, this committee is a Lobbyist/Registrant PAC.

Affiliated Committees/Organizations

UNITED FOOD AND COMMERCIAL WORKERS INTERNATIONAL UNION
1775 K STREET N.W.
WASHINGTON, DC 200061598
Affiliated Relationship Code: Connected Organization

RETAIL WHOLESALE & DEPARTMENT STORE UN
30 EAST 29TH STREET
NEW YORK, New York 10016
Affiliated Relationship Code: Affiliated Committee

UNITED FOOD AND COMMERCIAL WORKERS INT
1775 K STREET N.W.
WASHINGTON, DC 200061598
Affiliated Relationship Code: Affiliated Committee

Custodian of Records:

ANTHONY M. PERRONE
1775 K STREET N.W.
WASHINGTON, DC 200061598
Title: (202) 223-3111
Phone # (202) 223-3111

Treasurer:

Anthony M. Perrone
1775 K STREET N.W.
WASHINGTON, DC 200061598
Title: SECRETARY-TREASURER
Phone # (202) 223-3111

Designated Agent(s):

Banks or Depositories

CHEVY CHASE BANK
6151 CHEVY CHASE DRIVE
LAUREL, Maryland 20707

Signed: Anthony M. Perrone
Date Signed: 06/28/2010

(End FEC FORM 1)

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