FEC Form 1 for NATIONAL CHICKEN COUNCIL POLITICAL ACTION COMMITTEE (FKA) NATIONAL BROILER COUNCIL PACForm 1 for NATIONAL CHICKEN COUNCIL POLITICAL ACTION COMMITTEE (FKA) NATIONAL BROILER COUNCIL PAC

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-717757

1. NATIONAL CHICKEN COUNCIL POLITICAL ACTION COMMITTEE (FKA) NATIONAL BROILER COUNCIL PAC

1015 FIFTEENTH STREET NW
WASHINGTON, DC 20005
Email: NCCPAC@Chickenusa.org

2. Date: 03/17/2011

3. FEC Committee ID #: C00034272 This committee is a separate segregated fund. Its connected organization is a

Affiliated Committees/Organizations

National Chicken Council
1015 15th Street, NW
Washington, DC 20005
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Ms. Mary Millicent Colville
1015 15th St., NW
Suite 930
Washington, DC 20005
Title: Custodian of Records
Phone # (202) 296-2622

Treasurer:

Mr. Michael J. Brown
1015 15th Street, NW
Washington, DC 20005
Title: Treasurer
Phone # (202) 296-2622

Designated Agent(s):

Banks or Depositories

Wachovia Bank
P.O. Box 563966
Charlotte, North Carolina 28262

Signed: Mr. Michael J. Brown
Date Signed: 03/17/2011

(End FEC FORM 1)

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