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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-85704

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1. United Seniors PAC Inc.

    209 Pennsylvania Avenue SE
    Suite 800
    Washington, DC 20003

    NOTE: Address is different than previously reported

    Fax: 6053628501
    Email: unitedseniorspac@yahoo.com

2. Date: 05/21/2003

3. FEC Committee ID #: C00077354

This committee supports/opposes more than one Federal candidate and is NOT a separate segregated fund or a party committee.

Affiliated Committees/Organizations

Custodian of Records:

Paul Erickson
4904 Oxbow Avenue
Suite 305
Sioux Falls, SD 57106
Title: Chairman/Treasurer
Phone # (605) 362-8500

Treasurer:

Paul Erickson
4904 Oxbow Avenue
Suite 305
Sioux Falls, South Dakota 57106
Title: Chairman/Treasurer
Phone # (605) 362-8500

Designated Agent(s):

Banks or Depositories

Signed: Paul Erickson
Date Signed: 05/21/2003
Official Committee FAX: 6053628501

(End FEC FORM 1)

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