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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1193533

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1. Baker Donelson Bearman Caldwell & Berkowitz PC PAC

    901 K Street NW Suite 900
    Washington, DC 20001
    Email: mvandewater@BakerDonelson.com

    NOTE: Email address is different than previously reported

2. Date: 12/11/2017

3. FEC Committee ID #: C00431072 This committee is a separate segregated fund. Its connected organization is a Corporation
     In addition, this committee is a Lobbyist/Registrant PAC.

Affiliated Committees/Organizations

Committee ID# C00431072
Baker Donelson Bearman Caldwell & Berkowitz PC PAC
901 K Street NW Suite 900
Washington, DC 20001
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Mark Van de Water
901 K Street NW Suite 900
Washington, DC 20001
Title: Custodian of Records
Phone # (202) 508-3407

Treasurer:

Mark Van de Water
901 K Street NW Suite 900
Washington, DC 20001
Title: Treasurer
Phone # (202) 508-3407

Designated Agent(s):

Nathan Daschle
901 K Street NW Suite 900
Washington, DC 20001
Title: Assistant Treasurer
Phone # (202) 508-3438

Banks or Depositories

Suntrust Bank
P.O. Box 26150
Richmond, Virginia 23260

Signed: Mark Van de Water
Date Signed: 12/15/2017

FORM TEXT-1

(End FEC FORM 1)

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