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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1017443

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1. Golden State Political Action Committee

    249 E. Ocean Blvd., Suite 685
    Long Beach, CA 90802

    NOTE: Address is different than previously reported

    Email: dlgould@gouldorellana.com

    NOTE: Email address is different than previously reported

2. Date: 07/23/2015

3. FEC Committee ID #: C00145342

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

Affiliated Committees/Organizations

None
, ____

Custodian of Records:

David Gould
249 East Ocean Blvd., Suite 685
Long Beach, CA 90802
Title: Custodian of Records
Phone # (213) 489-4792

Treasurer:

David Gould
249 East Ocean Blvd., Suite 685
Long Beach, California 90802
Title: Treasurer
Phone # (213) 489-4792

Designated Agent(s):

Ingrid Orellana
249 East Ocean Blvd., Suite 685
Long Beach, California 90802
Title: Assistant Treasurer
Phone # (213) 489-4792

Nadia Modesto (Asst. Treasurer)
249 East Ocean Blvd., Suite 685
Long Beach, California 90802
Title: Assistant Treasurer
Phone # (213) 489-4792

Banks or Depositories

City National Bank
555 S. Flower St.
Los Angeles, California 90071

Signed: David L. Gould
Date Signed: 07/23/2015

(End FEC FORM 1)

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