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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1178587

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1. National Community Pharmacists Association - PAC

    100 Daingerfield Road
    Alexandria, VA 223142885
    Email: karry.laviolette@ncpanet.org

2. Date: 08/10/2017

3. FEC Committee ID #: C00030809 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

National Community Pharmacists Association
100 Daingerfield Road
Alexandria, Virginia 223142885
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Ms. Kendal Ann Miller
100 Daingerfield Rd
Alexandria, VA 22314
Title: Custodian f Records
Phone # (703) 838-2695

Treasurer:

Ms. Karry LaViolette
100 Daingerfield Road
Alexandria, Virginia 22314
Title: Treasurer
Phone # (703) 600-1180

Designated Agent(s):

Ms. Kendal Ann Miller
100 Daingerfield Rd
Alexandria, Virginia 22314
Title: Custodian f Records
Phone # (703) 838-2695

Banks or Depositories

SunTrust
P.O. Box 179
Alexandria, Virginia 22314

Signed: Ms. Karry LaViolette
Date Signed: 08/10/2017

(End FEC FORM 1)

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