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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1179512

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1. UNITED MINE WORKERS OF AMERICA - COAL MINERS POLITICAL ACTION COMMITTEE

    18354 QUANTICO GATEWAY DR
    SUITE 200
    TRIANGLE, VA 22172
    Email: mdelbalzo@umwa.org;lallen@umwa.org

2. Date: 07/12/2017

3. FEC Committee ID #: C00013342 This committee is a separate segregated fund. Its connected organization is a Labor Organization

Affiliated Committees/Organizations

1United Mine Workers of America
18354 Quantico Gateway Dr
Suite 200
Triangle, Virginia 22172
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Levi Allen
15 Saint Claires Court
Stafford, VA 22556
Title: Secretary-Treasurer
Phone # (703) 291-2406

Treasurer:

Levi Allen
15 Saint Claires Court
Stafford, Virginia 22556
Title: Secretary-Treasurer
Phone # (703) 291-2406

Designated Agent(s):

Levi Allen
15 Saint Claires Court
Stafford, Virginia 22556
Title: Secretary-Treasurer
Phone # (703) 291-2406

Levi Allen
15 Saint Claires Court
Stafford, Virginia 22556
Title: Secretary-Treasurer
Phone # (703) 291-2406

Banks or Depositories

Bank of Labor
756 Minnesota Avenue
Kansas City, Kansas 66101

Signed: Levi Allen
Date Signed: 08/17/2017
Official Committee URL: www.umwa.org

(End FEC FORM 1)

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