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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1042521

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1. Relyance Bank Political Action Committee - Federal

    P.0. Box 7878
    912 S Poplar
    Pine Bluff, AR 716117878
    Email: relypac@relybank.com;shafera@relybank.com

2. Date: 01/06/2016

3. FEC Committee ID #: C00278754 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

Relyance Bank
P.0. Box 7878
912 S Poplar
Pine Bluff, Arkansas 71611
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Anita Shafer-Durham
912 S Poplar
Pine Bluff, AR 71601
Title: PAC Treasurer
Phone # (870) 535-7222

Treasurer:

Anita Shafer-Durham
912 S Poplar
Pine Bluff, Arkansas 71601
Title: PAC Treasurer
Phone # (870) 535-7222

Designated Agent(s):

Anita Shafer-Durham
912 S Poplar
Pine Bluff, Arkansas 71601

Banks or Depositories

Relyance Bank
P.0. Box 7878
912 S Poplar
Pine Bluff, Arkansas 71611

Signed: Anita Shafer-Durham
Date Signed: 01/01/2016

(End FEC FORM 1)

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