FEC Form 1 for 1199 SERVICE EMPLOYEES INT'L UNION FEDERAL POLITICAL ACTION FUNDForm 1 for 1199 SERVICE EMPLOYEES INT'L UNION FEDERAL POLITICAL ACTION FUND

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-399692

1. 1199 SERVICE EMPLOYEES INT'L UNION FEDERAL POLITICAL ACTION FUND

330 WEST 42ND STREET, 7TH FLOOR
NEW YORK, NY 10036

2. Date: 01/16/2009

3. FEC Committee ID #: C00348540 This committee is a separate segregated fund. Its connected organization is a

Affiliated Committees/Organizations

SERVICE EMPLOYEES INT'L UNION
1313 L. STREET N.W.
WASHINGTON, DC 20036
Affiliated Relationship Code: Connected Organization

SERVICE EMPLOYEES INT'L UNION COMM.ON
1313 L. STREET N.W.
WASHINGTON, DC 20036
Affiliated Relationship Code: Connected Organization

Custodian of Records:

KEVIN FINNEGAN
330 WEST 42ND STREET, 7TH FLOOR
NEW YORK, NY 10036
Title: TREASURER
Phone # (212) 603-1743

Treasurer:

KEVIN FINNEGAN
330 WEST 42ND STREET, 7TH FLOOR
NEW YORK, New York 10036
Title: TREASURER
Phone # (212) 603-1743

Designated Agent(s):

Banks or Depositories

TD BANK
1710 ROUTE 70 EAST
CHERRY HILL, New Jersey 08034

Signed: KEVIN FINNEGAN
Date Signed: 01/30/2009

(End FEC FORM 1)

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