FEC Form 1 for American Physical Therapy Association Physical Therapy Political Action Committee (PT-PAC)Form 1 for American Physical Therapy Association Physical Therapy Political Action Committee (PT-PAC)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1002524

1. American Physical Therapy Association Physical Therapy Political Action Committee (PT-PAC)

1111 North Fairfax St.
Alexandria, VA 22314
Email: MichaelMatlack@APTA.org

2. Date: 04/14/2015

3. FEC Committee ID #: C00012880 This committee is a separate segregated fund. Its connected organization is a Membership Organization
In addition, this committee is a Lobbyist/Registrant PAC.

Affiliated Committees/Organizations

American Physical Therapy Association
1111 North Fairfax Street
Alexandria, Virginia 22314
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Michael Matlack
1111 North Fairfax Street
Alexandria, VA 22314
Title: Associate Director o
Phone # (703) 706-3163

Treasurer:

Mr Justin Moore
1111 North Fairfax St.
Alexandria, Virginia 22314
Title: Vice President of Go
Phone # (703) 706-3162

Designated Agent(s):

Banks or Depositories

SunTrust Bank
P.O. Box 622227
Orlando, Florida 32862

Wells Fargo Bank, N.A.
P.O. Box 63020
San Francisco, California 94163

Signed: Mr Justin Moore
Date Signed: 04/14/2015
Official Committee URL: www.apta.org

FORM TEXT-1

(End FEC FORM 1)

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