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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-870067

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1. Telecommunications Industry Association Broadband PAC

    2500 Wilson Blvd., Suite 300
    Arlington, VA 22201
    Email: mwaters@tiaonline.org;accounting@tiaonline.org

2. Date: 05/08/2013

3. FEC Committee ID #: C00383356 This committee is a separate segregated fund. Its connected organization is a Trade Association

Affiliated Committees/Organizations

Telecommunications Industry Association
1320 Wilson Blvd., Suite 200
Arlington, Virginia 22201
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Treasurer:

Mary Waters
2500 Wilson Blvd., Suite 300
Arlington, Virginia 22201
Title: Senior Director
Phone # (703) 907-7701

Designated Agent(s):

Banks or Depositories

Suntrust Bank
P.O Box 622227
Orlando, Florida 32862

Signed: Mary Waters
Date Signed: 05/08/2013

(End FEC FORM 1)

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