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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-846096

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1. I.U.O.E LOCAL 15 POLITICAL ACTION COMMITTE

    44-40 11TH STREET
    LONG ISLAND CITY, NY 111015105

    NOTE: Address is different than previously reported

    Email: kerryo@iuoe15.org

2. Date: 01/08/2013

3. FEC Committee ID #: C00163956 This committee is a separate segregated fund. Its connected organization is a Labor Organization

Affiliated Committees/Organizations

I.U.O.E LOCAL 15
44-40 11TH STREET
LONG ISLAND CITY, New York 111015105
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Treasurer:

ROBERT J. BURNS
44-40 11TH STREET
LONG ISLAND CITY, New York 111015105
Title: Treasurer
Phone # (212) 929-5327

Designated Agent(s):

Banks or Depositories

HSBC BANK USA
80 EIGHTH AVE
NEW YORK, New York 10011

Signed: ROBERT J. BURNS
Date Signed: 01/10/2013

(End FEC FORM 1)

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