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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-732187

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1. Harris N.A. Government Affairs Fund

    111 W. Monroe
    P.O. Box 755
    Chicago, IL 60603
    Email: carl.jenkins@harrisbank.com

    NOTE: Email address is different than previously reported

2. Date: 06/20/2011

3. FEC Committee ID #: C00086256 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

Harris N.A.
111 West Monroe St.
Chicago, Illinois 60603
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Treasurer:

Carl Jenkins
2639A South Michigan Ave
Chicago, Illinois 60616
Title: Treasurer
Phone # (312) 461-6158

Designated Agent(s):

Banks or Depositories

Harris N.A.
111 West Monroe St.
P.O. Box 755
Chicago, Illinois 60603

Signed: Carl Jenkins
Date Signed: 06/20/2011

(End FEC FORM 1)

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