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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-834724

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1. LOUISIANA SHERIFFS AND DEPUTIES POLITICAL ACTION COMMITTEE

    1175 NICHOLSON DR
    BATON ROUGE, LA 70802
    Email: cindy@lsa.org;jimmy@burland.org

    NOTE: Email address is different than previously reported

2. Date: 11/27/2012

3. FEC Committee ID #: C00357905 This committee is a separate segregated fund. Its connected organization is a Trade Association

Affiliated Committees/Organizations

Louisiana Sheriffs Association
1175 Nicholson Drive
Baton Rouge, Louisiana 70802
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Mike Cazes
1175 Nicholson Drive
Baton Rouge, LA 70802
Title: Treasurer
Phone # (225) 343-8402

Treasurer:

Mike Cazes
1175 Nicholson Drive
Baton Rouge, Louisiana 70802
Title: Treasurer
Phone # (225) 343-8402

Designated Agent(s):

Wayne Morein
302 U.S. 167 N.
Ville Platte, Louisiana 70586

Banks or Depositories

Chase Bank
POB 3399
Baton Rouge, Louisiana 70821

Signed: Mike Cazes
Date Signed: 11/27/2012
Official Committee URL: www.lsa.org

(End FEC FORM 1)

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