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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-807147

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1. STEAMFITTERS LOCAL 475 POLITICAL ACTION COMMITTEE

    P.O. BOX 4187
    136 MOUNT BETHEL ROAD
    WARREN, NJ 07059
    Email: RLeffert@ualocal475.org

2. Date: 08/23/2012

3. FEC Committee ID #: C00252395 This committee is a separate segregated fund. Its connected organization is a Labor Organization

Affiliated Committees/Organizations

STEAMFITTERS LOCAL 475
136 Mount Bethel Rd
PO Box 4187
Warren, New Jersey 07059
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Robin Leffert
P.O. Box 4187
136 Mount Bethel Road
Warren, NJ 07059
Title: Bookkeeper
Phone # (908) 754-1030

Treasurer:

Michael Mulvaney
890 Roundtree Drive
Toms River, New Jersey 08724
Title: Fin. Sec. Treasurer
Phone # (908) 754-1030

Designated Agent(s):

Banks or Depositories

TD Bank, N.A.
2059 Springdale Road
Cherry Hill, New Jersey 08003

Signed: Michael Mulvaney
Date Signed: 08/23/2012
Official Committee URL: UALOCAL475.ORG

(End FEC FORM 1)

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