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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-433171

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1. Life Insurance Settlement Association PAC

    NOTE:Commmittee Name is different than previously reported

    1011 E Colonial Dr
    Ste 500
    Orlando, FL 32803
    Email: lisapac@lisassociation.org

    NOTE: Email address is different than previously reported

2. Date: 09/22/2009

3. FEC Committee ID #: C00431973 This committee is a separate segregated fund. Its connected organization is a Trade Association

Affiliated Committees/Organizations

Life Insurance Settlement Association
1011 E Colonial Dr
Ste 500
Orlando, Florida 32803
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Madeline Garcia
1011 E Colonial Dr
Ste 500
Orlando, FL 32803
Title: Acct Services Rep
Phone # (407) 894-3797

Treasurer:

William Potoczak
1339 West 49th St
Cleveland, Ohio 44102
Title: Treasurer
Phone # (216) 464-7481

Designated Agent(s):

Doug Head
1011 E Colonial Dr
Ste 500
Orlando, Florida 32803
Title: Asst. Treasurer
Phone # (407) 894-3797

Banks or Depositories

Bank of America
PO Box 2485
Spokane, Washington 992102485

Signed: William Potoczak
Date Signed: 09/22/2009
Official Committee URL: http://www.thevoiceoftheindustry.com/content/59/LISAPAC.aspx

FORM TEXT

(End FEC FORM 1)

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