FEC FORM 1
STATEMENT OF ORGANIZATION
FILING FEC-1163722
1. Independence USA PAC
PO BOX 1510New York, NY 10150
Email: compliance@independenceusapac.org
NOTE: Email address is different than previously reported
2. Date: 01/28/2013
3. FEC Committee ID #: C00532705This committee supports/opposes more than one Federal candidate and is NOT a separate segregated fund or a party committee.
Affiliated Committees/Organizations
NONE
, ____
Custodian of Records:
Diane Gubelli
909 Third Avenue
15th Floor
New York, NY 10022
Title: Custodian of Records
Phone # (212) 583-6000
Treasurer:
Diane Gubelli
909 Third Avenue
15th Floor
New York, New York 10022
Title: Treasurer
Phone # (212) 583-6000
Designated Agent(s):
Banks or Depositories
U.S. Trust, Bank of America Private We
114 W. 47th St.
6th Floor
New York, New York 10036
Signed: Diane Gubelli
Date Signed: 05/20/2017
(End FEC FORM 1)
Date Signed: 05/20/2017