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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-778943

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1. National Agricultural Aviation Association Ag-Av PAC

    1005 E Street S.E.
    Washington, DC 20003

    NOTE: Address is different than previously reported

    Email: piknizner@agaviation.org

2. Date: 04/11/2012

3. FEC Committee ID #: C00341701 This committee is a separate segregated fund. Its connected organization is a Trade Association

Affiliated Committees/Organizations

National Agricultural Aviation Association
1005 E Street SE
Washington, DC 20003
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Treasurer:

Mr. Randy Hale
5138 Co. Rd. 44
Robstown, Texas 78380
Title: AG AV PAC Treasurer
Phone # (202) 546-5722

Designated Agent(s):

Banks or Depositories

Wells Fargo Bank
215 Pennsylvania Avenue SE
Washington, DC 20003

Signed: Mr. Randy Hale
Date Signed: 04/17/2012

(End FEC FORM 1)

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