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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-429741

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1. Polsinelli Shughart PC PAC

    NOTE:Commmittee Name is different than previously reported

    1152 15th Street, NW
    Suite 800
    Washington, DC 20005
    Email: pac@polsinelli.com

2. Date: 08/17/2009

3. FEC Committee ID #: C00445981 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

Custodian of Records:

Julian Arredondo
700 West 47th Street, NW
Suite 1000
Kansas City, MO 64112
Phone # (816) 753-1000

Treasurer:

Julian Arredondo
700 West 47th Street
Suite 1000
Kansas City, Missouri 64112
Phone # (816) 753-1000

Designated Agent(s):

James H Davidson
1152 15th Street, NW
Suite 800
Washington, DC 20005
Phone # (202) 783-3300

Banks or Depositories

US Bank
1201 Wyandotte
Kansas City, Missouri 64106

Signed: Mr. Julian Arredondo
Date Signed: 08/17/2009

(End FEC FORM 1)

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