FEC Form 1 for Assurant Inc. Political Action CommitteeForm 1 for Assurant Inc. Political Action Committee

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1032710

1. Assurant Inc. Political Action Committee

501 W. Michigan St
Milwaukee, WI 53203
Email: Robert.Schwarz@assurant.com

NOTE: Email address is different than previously reported

2. Date: 11/13/2015

3. FEC Committee ID #: C00185694 This committee is a separate segregated fund. Its connected organization is a Corporation
In addition, this committee is a Lobbyist/Registrant PAC.

Affiliated Committees/Organizations

Assurant Inc.
1 Chase Manhattan Plaza
New York, New York 10005
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Jane Holter
28 Liberty Street
New York, NY 10005
Title: Assistant Treasurer
Phone # (212) 859-5833

Treasurer:

Robert Schwarz
28 Liberty Street
New York, New York 10005
Title: Treasurer
Phone # (212) 859-7023

Designated Agent(s):

Jane Holter
28 Liberty Street
New York, New York 10005
Title: Assistant Treasurer
Phone # (212) 859-5833

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1032710

1. Assurant Inc. Political Action Committee

NOTE: Email address is different than previously reported

2. Date: 11/13/2015

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: Robert Schwarz
Date Signed: 11/13/2015

(End FEC FORM 1)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1032710

1. Assurant Inc. Political Action Committee

NOTE: Email address is different than previously reported

2. Date: 11/13/2015

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: Robert Schwarz Date Signed: 11/13/2015

(End FEC FORM 1)

Signed: Robert Schwarz
Date Signed: 11/13/2015