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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1206306

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1. Erie Indemnity Company PAC - Federal

    100 Erie Insurance Place
    Erie, PA 16530
    Email: fecinfo@pass1.com

    NOTE: Email address is different than previously reported

2. Date: 02/02/2018

3. FEC Committee ID #: C00153577 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

Erie Indemnity Company
100 Erie Insurance Place
Erie, Pennsylvania 16530
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Mark Dombrowski
c/o PASS
1950 Roland Clarke Pl Ste 300
Reston, VA 20191
Title: Custodian of Records
Phone # (703) 476-3070

Treasurer:

Mark Dombrowski
100 Erie Insurance Place
Erie, Pennsylvania 16530
Title: Treasurer
Phone # (814) 870-6979

Designated Agent(s):

Kimberly McWilliams
100 Erie Insurance Place
Erie, Pennsylvania 16530
Title: Assistant Treasurer
Phone # (814) 870-7266

Banks or Depositories

PNC Bank
9th & State Streets
Erie, Pennsylvania 16533

Signed: Mark Dombrowski
Date Signed: 02/02/2018
Official Committee URL: None

FORM TEXT-1

(End FEC FORM 1)

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