FEC Form 1 for ACADIAN AMBULANCE SERVICE EMPLOYEE FEDERAL POLITICAL ACTION COMMITTEE, INC.Form 1 for ACADIAN AMBULANCE SERVICE EMPLOYEE FEDERAL POLITICAL ACTION COMMITTEE, INC.

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1140208

1. ACADIAN AMBULANCE SERVICE EMPLOYEE FEDERAL POLITICAL ACTION COMMITTEE, INC.

P.O. BOX 98000
LAFAYETTE, LA 70509
Email: beth.leblanc@acadian.com;marie.roulstone@acadian.com

2. Date: 01/20/2017

3. FEC Committee ID #: C00335570 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

Acadian Ambulance Service
P.O. Box 98000
Lafayette, Louisiana 70509
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Mrs. Erin Z. LeBlanc
214 Hidden Grove Place
Lafayette, LA 70503
Title: Associate Counsel
Phone # (337) 291-4030

Treasurer:

Mrs. Erin Z. LeBlanc
214 Hidden Grove Place
Lafayette, Louisiana 70503
Title: Associate Counsel
Phone # (337) 291-4030

Designated Agent(s):

Banks or Depositories

JP Morgan Chase Bank
PO Box 260180
Baton Rouge, Louisiana 70826

Signed: Mrs. Erin Z. LeBlanc
Date Signed: 01/20/2017
Official Committee URL: http://www.acadian.com

(End FEC FORM 1)

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