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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1161328

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1. EMGAGE FEDERAL POLITICAL ACTION COMMITTEE

    NOTE:Commmittee Name is different than previously reported

    3425 US HWY 98 NORTH
    LAKELAND, FL 33809
    Email: khurrum@wvmlawfirm.com;fmitha@gmail.com

    NOTE: Email address is different than previously reported

2. Date: 05/05/2017

3. FEC Committee ID #: C00453704 This committee is a separate segregated fund. Its connected organization is a Membership Organization

Affiliated Committees/Organizations

Emgage Action, Inc.
3425 US Hwy 98 North
Lakeland, Florida 33809
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Khurrum Wahid
1828 NW 124th Ave
Coral Springs, FL 33071
Title: Chairman
Phone # (305) 310-0681

Treasurer:

Amin Mitha
3425 US Hwy 98 N
Lakeland, Florida 33809
Title: Treasurer
Phone # (863) 858-4481

Designated Agent(s):

Khurrum Wahid
1828 NW 124th Ave
Coral Springs, Florida 33071
Title: Chairman
Phone # (863) 858-4481

Banks or Depositories

BB&T
4420 US Hwy 98 North
Lakeland, Florida 33809

Signed: Amin Mitha
Date Signed: 05/05/2017
Official Committee URL: www.emgagepac.org

NOTE: URL is different than previously reported

(End FEC FORM 1)

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