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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-984279

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1. UCB, INC. POLITICAL ACTION COMMITTEE

    2350 KERNER BLVD., SUITE 250
    SAN RAFAEL, CA 94901
    Email: sscally@nmgovlaw.com;jskelton@nmgovlaw.com

2. Date: 12/19/2014

3. FEC Committee ID #: C00571141 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

UCB, INC.
1950 LAKE PARK DRIVE
SMYRNA, Georgia 30080
Affiliated Relationship Code: Connected Organization

Custodian of Records:

JENNIE UNGER SKELTON
2350 KERNER BLVD., SUITE 250
SAN RAFAEL, CA 94901
Title: Custodian of Records
Phone # (415) 389-6800

Treasurer:

JENNIE UNGER SKELTON
2350 KERNER BLVD., SUITE 250
SAN RAFAEL, California 94901
Title: Treasurer
Phone # (415) 389-6800

Designated Agent(s):

ERIN LAMA
2350 KERNER BLVD., SUITE 250
SAN RAFAEL, California 94901
Title: Assistant Treasurer
Phone # (415) 389-6800

Banks or Depositories

BANK OF MARIN
504 TAMALPAIS DRIVE
CORTE MADERA, California 94925

Signed: Jennie Unger Skelton
Date Signed: 12/19/2014

(End FEC FORM 1)

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