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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-344767

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1. Professional Insurance Agents Political Action Committee

    400 N. Washington Street
    Alexandria, VA 22314
    Fax: 7038361279
    Email: piapac@pianet.org

2. Date: 06/17/2008

3. FEC Committee ID #: C00004994 This committee is a separate segregated fund. Its connected organization is a Trade Association

Affiliated Committees/Organizations

National Association of Professional Insurance Agents
400 N. Washington Street
Alexandria, Virginia 22314
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Mr. Mike Becker
400 N. Washington Street
Alexandria, VA 22314
Title: Treasurer
Phone # (703) 518-1365

Treasurer:

Mr. Mike Becker
400 N. Washington Street
Alexandria, Virginia 22314
Title: Treasurer
Phone # (703) 518-1365

Designated Agent(s):

Mr. Mike Becker
400 N. Washington Street
Alexandria, Virginia 22314
Title: Treasurer
Phone # (703) 518-1365

Banks or Depositories

Sun Trust Bank
P.O. Box 622227
Orlando, Florida 32862

Signed: Mr. Mike Becker
Date Signed: 06/17/2008
Official Committee URL: http://www.pianet.org/piapac
Official Committee FAX: 7038361279

(End FEC FORM 1)

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