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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-775764

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1. AMERICAN INDIAN SOVEREIGNTY SELF-DETERMINATION & ECONOMIC PAC OF THE NATIONAL INDIAN ASSOC

    224 2ND STREET SE
    WASHINGTON, DC 20003
    Email: jgiles@indiangaming.org

    NOTE: Email address is different than previously reported

2. Date: 04/12/2012

3. FEC Committee ID #: C00367177 This committee is a separate segregated fund. Its connected organization is a Trade Association
     In addition, this committee is a Lobbyist/Registrant PAC.

Affiliated Committees/Organizations

National Indian Gaming Association
224 Second St. SE
Washington, DC 20003
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Jason Giles
224 Second Street, SE
Washington, DC 20003
Title: Treasurer
Phone # (202) 548-3810

Treasurer:

Jason Giles
224 Second Street, SE
Washington, DC 20003
Title: Treasurer
Phone # (202) 548-3810

Designated Agent(s):

Neil Reiff
300 M Street, SE
Suite 1102
Washington, DC 20003
Title: Assistant Treasurer
Phone # (202) 479-1111

Banks or Depositories

Wells Fargo
PO Box 63020
San Francisco, California 94163

Signed: Jason Giles
Date Signed: 04/12/2012

(End FEC FORM 1)

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