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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-266032

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1. ACADIAN AMBULANCE SERVICE INC. EMPLOYEE PAC

    P.O. BOX 98000
    LAFAYETTE, LA 70509
    Fax: 3372914469
    Email: tburke@acadian.com

2. Date: 12/19/2006

3. FEC Committee ID #: C00335570 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

Acadian Ambulance Service Inc.
P.O. Box 92970
Lafayette, Louisiana 70509
Relationship: Connected
Organization Type: Corporation

Custodian of Records:

TIMOTHY BURKE
221 VEROT SCHOOL RD #213
LAFAYETTE, LA 70501

Treasurer:

TIMOTHY BURKE
221 VEROT SCHOOL RD #213
LAFAYETTE, Louisiana 70501

Designated Agent(s):

Banks or Depositories

JP Morgan Chase Bank
Baton Rouge, Louisiana 70801

Signed: TIMOTHY BURKE
Date Signed: 12/19/2006
Official Committee URL: http://www.acadian.com
Official Committee FAX: 3372914469

(End FEC FORM 1)

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