FEC Form 1 for Polsinelli PACForm 1 for Polsinelli PAC

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-870206

1. Polsinelli PAC

NOTE:Commmittee Name is different than previously reported

700 West 47th Street
Suite 1000
Kansas City, MO 64112
Email: kblitz@polsinelli.com

2. Date: 04/22/2013

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

Affiliated Committees/Organizations

Committee ID# C00445981
Polsinelli PAC
700 West 47th Street
Suite 1000
Kansas City, Missouri 64112
Affiliated Relationship Code: Connected Organization

Custodian of Records:

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

Treasurer:

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

Designated Agent(s):

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

Banks or Depositories

US Bank
1201 Wyandotte
Kansas City, Missouri 64106

n/a

, ____

Signed: Mr. Julian Arredondo
Date Signed: 05/09/2013

FORM TEXT

(End FEC FORM 1)

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