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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1302807

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1. Bell Ambulance, Inc. Employees PAC

    549 E. Wilson Street
    Milwaukee, WI 53207
    Email: BellPAC@264Bell.com

2. Date: 01/03/2019

3. FEC Committee ID #: C00693390 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

Bell Ambulance, Inc.
549 E. Wilson Ave
Milwaukee, Wisconsin 53207
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Wayne Jurecki
549 E. Wilson Street
Milwaukee, WI 53207
Title: Vice President
Phone # (414) 486-4042

Treasurer:

Wayne Jurecki
549 E. Wilson Street
Milwaukee, Wisconsin 53207
Title: Vice President
Phone # (414) 486-4042

Designated Agent(s):

Angela Sather
549 E. Wilson Street
Milwaukee, Wisconsin 53207
Phone # (414) 486-4027

Banks or Depositories

Park Bank
14870 W. Greenfield Ave.
Brookfield, Wisconsin 53005

Signed: Wayne Jurecki
Date Signed: 01/03/2019

(End FEC FORM 1)

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