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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-992399

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1. JACKSON LEWIS P.C. POLITICAL ACTION COMMITTEE

    1133 WESTCHESTER AVE
    SUITE S125
    WEST HARRISON, NY 10604

    NOTE: Address is different than previously reported

    Email: joseph.kelley@jacksonlewis.com;joseph.kelley@jacksonlewis.com

2. Date: 02/02/2015

3. FEC Committee ID #: C00482570 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

JACKSON LEWIS P.C.
1133 WESTCHESTER AVE
SUITE S125
WEST HARRISON, New York 10604
Affiliated Relationship Code: Connected Organization

Custodian of Records:

JOSEPH KELLEY
1133 WESTCHESTER AVE
SUITE S125
WEST HARRISON, NY 10604
Title: CFO
Phone # (914) 872-1489

Treasurer:

JOSEPH KELLEY
1133 WESTCHESTER AVE
SUITE S125
WEST HARRISON, New York 10604
Title: CFO
Phone # (914) 872-1489

Designated Agent(s):

STEPHEN LASKA
1133 WESTCHESTER AVE
SUITE S125
WEST HARRISON, New York 10604
Title: Assitant Treasurer

Banks or Depositories

Citibank
244 Main Street
White Plains, New York 10601

Signed: JOSEPH KELLEY
Date Signed: 02/04/2015

(End FEC FORM 1)

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