FEC FORM 1
STATEMENT OF ORGANIZATION
FILING FEC-807238
1. UBS Americas Inc. Political Action Committee (UBS PAC)
400 ATLANTIC STREETc/o Per Dyrvik
STAMFORD, CT 06901
Email: SH-PAC_Administrator@ubs.com,pacservices@ddcadvocacy.com
2. Date: 08/23/2012
3. FEC Committee ID #: C00012245 This committee is a separate segregated fund. Its connected organization is a CorporationIn addition, this committee is a Lobbyist/Registrant PAC.
Affiliated Committees/Organizations
UBS Americas, Inc.400 ATLANTIC STREET
STAMFORD, Connecticut 06901
Affiliated Relationship Code: Connected Organization
Custodian of Records:
DDC Advocacy174 Waterfront Street
Suite 500
National Harbor, MD 20745
Title: Custodian of Records
Phone # (877) 332-6556
Treasurer:
Per Dyrvik400 Atlantic St
Stamford, Connecticut 069013512
Title: Treasurer
Phone # (203) 719-4381
Designated Agent(s):
Banks or Depositories
JPMorgan Chase Bank1251 Avenue of the Americas
New York, New York 10020