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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1164812

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1. Cozen O'Connor Political Action Committee

    One Liberty Place
    1650 Market Street
    Philadelphia, PA 19103
    Email: dellman@cozen.com

2. Date: 06/02/2017

3. FEC Committee ID #: C00312777 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

Cozen O'Connor
One Liberty Place
1650 Market Street
Philadelphia, Pennsylvania 19103
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Jaime Lake
One Liberty Place
1650 Market St.
Philadelphia, PA 19103
Title: Executive Assistant
Phone # (215) 665-2726

Treasurer:

David W. Ellman
1206 Stongs Lane
Ambler, Pennsylvania 19002
Title: Chief Oper. Officer
Phone # (215) 665-4655

Designated Agent(s):

Banks or Depositories

Mellon Bank
201 King of Prussia Road
Radnor, Pennsylvania 19087

Citibank, N.A.
1748 Broadway
New York, New York 10019

Signed: David W. Ellman
Date Signed: 06/05/2017

(End FEC FORM 1)

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