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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1021418

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1. Permobil Federal Political Action Committee

    300 Duke Drive
    Lebanon, TN 37090
    Email: chris.javillonar@permobil.com

2. Date: 08/12/2015

3. FEC Committee ID #: C00583229 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

Permobil Inc
300 Duke Drive
Lebanon, Tennessee 37090
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Christopher C Javillonar
300 Duke Drive
Lebanon, TN 37090
Title: Treasurer
Phone # (800) 736-0925

Treasurer:

Christopher C Javillonar
300 Duke Drive
Lebanon, Tennessee 37090
Title: Treasurer
Phone # (800) 736-0925

Designated Agent(s):

Banks or Depositories

Skandinaviska Enskilda Banken
245 Park Avenue, 33rd Floor
New York, New York 10167

Signed: Christopher C Javillonar
Date Signed: 08/12/2015

(End FEC FORM 1)

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