FEC Form 1 for PURDUE PHARMA INC. POLITICAL ACTION COMMITTEE (PURDUE PAC)Form 1 for PURDUE PHARMA INC. POLITICAL ACTION COMMITTEE (PURDUE PAC)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-122453

1. PURDUE PHARMA INC. POLITICAL ACTION COMMITTEE (PURDUE PAC)

c/o Henry Shaw CPA P.C.
106 Corporate Park Dr. Suite 307
White Plains, NY 106043819
Email: joseph.drelich@pharma.com

2. Date: 06/08/2004

3. FEC Committee ID #: C00370643 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

Purdue Pharma Inc.
One Stamford Forum
Stamford, Connecticut 069013431
Relationship: Connected
Organization Type: Corporation

Custodian of Records:

Joseph Drelich
One Stamford Forum
Stamford, CT 069013431
Title: Treasurer
Phone # (203) 588-8000

Treasurer:

Joseph Drelich
One Stamford Forum
Stamford, Connecticut 069013431
Title: Treasurer
Phone # (203) 588-8000

Designated Agent(s):

Robin Hogen
One Stamford Forum
Stamford, Connecticut 069013431
Title: Assistant Treasurer
Phone # (203) 588-8000

Banks or Depositories

JP Morgan Chase Bank
1411 Broadway
New York, New York 10018

UBS Financial Services Inc.
1735 Market St. 36th Floor
Philadelphia, Pennsylvania 191037501

Signed: Joseph Drelich
Date Signed: 06/13/2004

(End FEC FORM 1)

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