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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-747227

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1. INTERNATIONAL ASSOC. OF HEAT & FROST INSULATORS & ASBESTOS WORKERS LOCAL #12 FEDERAL PAC

    25-19 43rd AVENUE
    LONG ISLAND CITY, NY 11101
    Email: matty@insulatorslocal12.com

    NOTE: Email address is different than previously reported

2. Date: 10/11/2011

3. FEC Committee ID #: C00398040 This committee is a separate segregated fund. Its connected organization is a

Affiliated Committees/Organizations

INTERNATIONAL ASSOCIATION OF HEAT & FROST INSULATORS & ALLIED TRADES LOCAL UNION # 12
25-19 43RD AVENUE
LONG ISLAND CITY, New York 11101
Affiliated Relationship Code: Connected Organization

Custodian of Records:

NICK GRGAS
25-19 43RD AVENUE
LONG ISLAND CITY, NY 11101
Title: PRESIDENT
Phone # (718) 784-3456

Treasurer:

Matthew Aracich
25-19 43rd Avenue
Long Island City, New York 11101
Title: TREASURER
Phone # (718) 784-3456

Designated Agent(s):

DENNIS J IPPOLITO
25-19 43RD AVENUE
LONG ISLAND CITY, New York 11101
Title: BUSINESS MANAGER
Phone # (718) 784-3456

Banks or Depositories

JP MORGAN CHASE BANK
10-51 JACKSON AVENUE
LONG ISLAND CITY, New York 11101

Signed: Matthew Aracich
Date Signed: 10/11/2011

(End FEC FORM 1)

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