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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-764193

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1. Coastal Federal Credit Union PAC

    1000 St. Albans Drive
    Raleigh, NC 27609
    Email: CoastalfcuPAC@ccoastalfcu.org

2. Date: 01/31/2012

3. FEC Committee ID #: C00342733 This committee is a separate segregated fund. Its connected organization is a Membership Organization

Affiliated Committees/Organizations

NONE
, ____

Custodian of Records:

RICHARD BURCHILL
1000 ST. ALBANS DRIVE
RALEIGH, NC 27609
Title: ASST TREASURER
Phone # (919) 420-8027

Treasurer:

BRADLEY MILLER
1000 ST ALBANS DRIVE
RALEIGH, North Carolina 27609
Title: TREASURER
Phone # (919) 420-8251

Designated Agent(s):

Banks or Depositories

Coastal Federal Credit Union
1000 St. Albans Drive
Raleigh, North Carolina 27609

Signed: RICHARD BURCHILL
Date Signed: 01/31/2012

(End FEC FORM 1)

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