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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1576898

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1. BLACK RIFLE COFFEE PAC (BLACK RIFLE COFFEE CO.)

    1144 SOUTH 500 WEST
    SALT LAKE CITY, UT 84101
    Email: KAYLA@CROSBYOTT.COM

2. Date: 03/30/2022

3. FEC Committee ID #: C00810911 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

BLACK RIFLE COFFEE CO.
1144 SOUTH 500 WEST
SALT LAKE CITY, Utah 84101
Affiliated Relationship Code: Connected Organization

Custodian of Records:

KAYLA GLAZE
1144 SOUTH 500 WEST
SALT LAKE CITY, UT 84101
Title: TREASURER

Treasurer:

KAYLA GLAZE
1144 SOUTH 500 WEST
SALT LAKE CITY, Utah 84101
Title: TREASURER

Designated Agent(s):

Banks or Depositories

CHAIN BRIDGE BANK
1445-A LAUGHLIN AVENUE
MCLEAN, Virginia 22101

Signed: KAYLA GLAZE
Date Signed: 03/30/2022

(End FEC FORM 1)

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