FEC Form 1 for HEARPAC OF HEARING INDUSTRIES ASSOCIATIONForm 1 for HEARPAC OF HEARING INDUSTRIES ASSOCIATION

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-407924

1. HEARPAC OF HEARING INDUSTRIES ASSOCIATION

1444 I St., NW, Suite 700
Washington, DC 20005
Email: hearpac@hearing.org

2. Date: 03/17/2009

3. FEC Committee ID #: C00437798 This committee is a separate segregated fund. Its connected organization is a Trade Association
In addition, this committee is a Lobbyist/Registrant PAC.

Affiliated Committees/Organizations

Hearing Industries Association
1444 I St. NW Suite 700
Washington, DC 20005
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Carole Rogin
600 Second St.
Apt. 401
Alexandria, VA 22314
Title: Vice President
Phone # (202) 712-9033

Treasurer:

Jerome Ruzicka
16110 46th Ave. N
Plymouth, Minnesota 55446
Title: Treasurer
Phone # (952) 941-6401

Designated Agent(s):

Carole Rogin
600 Second St.
Apt. 401
Alexandria, Virginia 22314
Title: Vice President

Banks or Depositories

American Charter Bank
459 S. Rand Rd.
Lake Zurich, Illinois 60047

Burke & Herbert
100 Fairfax St.
Alexandria, Virginia 22314

Signed: Jerome Ruzicka
Date Signed: 03/17/2009
Official Committee URL: www.hearing.org

(End FEC FORM 1)

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