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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-908836

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1. National Association of Convenience Stores Political Action Committee

    1600 Duke Street
    Alexandria, VA 22314
    Email: nacspac@nacsonline.com;dbirdsong@nacsonline.com

2. Date: 02/20/2014

3. FEC Committee ID #: C00126763 This committee is a separate segregated fund. Its connected organization is a Trade Association
     In addition, this committee is a Lobbyist/Registrant PAC.

Affiliated Committees/Organizations

National Association of Convenience Stores
1600 Duke Street
Alexandria, Virginia 22314
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Dana Birdsong
1600 Duke Street
Alexandria, VA 22314
Title: Custodian of Records
Phone # (703) 518-4227

Treasurer:

Mr. Lyle Beckwith
1600 Duke Street
Alexandria, Virginia 22314
Title: Treasurer
Phone # (703) 684-3600

Designated Agent(s):

Dana Birdsong
1600 Duke Street
Alexandria, Virginia 22314
Title: Assistant Treasurer
Phone # (703) 518-4227

Banks or Depositories

Chain Bridge Bank
1445-A Laughlin Avenue
McLean, Virginia 22101

Signed: Mr. Lyle Beckwith
Date Signed: 02/20/2014

(End FEC FORM 1)

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