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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-849558

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1. Independence USA PAC

    575 7th Street, NW
    Washington, DC 20004
    Email: info@independenceusapac.org

2. Date: 01/28/2013

3. FEC Committee ID #: C00532705

This 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: 01/28/2013

FORM TEXT

(End FEC FORM 1)

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