FEC Form 1 for Avery Dennison Corporation Employee Political Action Committee (ADePAC)Form 1 for Avery Dennison Corporation Employee Political Action Committee (ADePAC)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-898484

1. Avery Dennison Corporation Employee Political Action Committee (ADePAC)

455 Capitol Mall, Suite 600
Sacramento, CA 95814
Email: feccomm@bmhlaw.com

2. Date: 12/20/2013

3. FEC Committee ID #: C00467340 This committee is a separate segregated fund. Its connected organization is a Corporation
In addition, this committee is a Lobbyist/Registrant PAC.

Affiliated Committees/Organizations

Avery Dennison Corporation
207 Goode Avenue
Glendale, California 92103
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Ashlee Titus
455 Capitol Mall, Suite 600
Sacramento, CA 95814
Title: Custodian of Records
Phone # (916) 442-7757

Treasurer:

Ashlee Titus
455 Capitol Mall, Suite 600
Sacramento, California 95814
Title: Treasurer
Phone # (916) 442-7757

Designated Agent(s):

Thomas W. Hiltachk
455 Capitol Mall, Suite 600
Sacramento, California 95814
Title: Assistant Treasurer
Phone # (916) 442-7757

Banks or Depositories

California Bank & Trust
550 S. Hope Street, Suite 100
Los Angeles, California 90071

Signed: Ashlee N. Titus
Date Signed: 12/20/2013

FORM TEXT

(End FEC FORM 1)

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