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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-431457

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1. International Union of Operating Engineers Local 841 PAC (IUOE841 PAC)

    P.O. Box 2157
    Terre Haute, IN 47802

    NOTE: Address is different than previously reported

    Email: mbryan@iuoelocal841.com

2. Date: 09/01/2009

3. FEC Committee ID #: C00458794 This committee is a separate segregated fund. Its connected organization is a Labor Organization

Affiliated Committees/Organizations

Internationl Union of Operating Engineers Local 841
P.O. Box 2157
Terre Haute, Indiana 47802
Affiliated Relationship Code: Connected Organization

International Union of Operating Engin
1125 17th Street
Washington, DC 20036
Affiliated Relationship Code: Affiliated Committee

Custodian of Records:

Marilyn Bryan
P.O. Box 2157
Terre Haute, IN 47802
Title: Rec. & Corr. Sec.
Phone # (812) 299-1177

Treasurer:

Thomas M. Ridge
P.O. Box 2157
Terre Haute, Indiana 47802
Title: Treasurer
Phone # (812) 299-1177

Designated Agent(s):

Mark P. Spires
P.O. Box 2157
Terre Haute, Indiana 47802
Title: Assistant Treasurer
Phone # (812) 299-1177

Banks or Depositories

First Financial Bank
One First Financial Plaza
Terre Haute, Indiana 47807

Signed: Thomas M. Ridge
Date Signed: 09/03/2009

(End FEC FORM 1)

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