FEC Form 1 for CAP-PAC separate segregated fund of National Community Action Foundation, Inc.Form 1 for CAP-PAC separate segregated fund of National Community Action Foundation, Inc.

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-414907

1. CAP-PAC separate segregated fund of National Community Action Foundation, Inc.

1 Massachusetts Avenue, NW
Suite 310
WASHINGTON, DC 20001
Email: kelliebaker@ncaf.org

2. Date: 04/21/2009

3. FEC Committee ID #: C00163048 This committee is a separate segregated fund. Its connected organization is a Corporation W/O Capital Stock
In addition, this committee is a Lobbyist/Registrant PAC.

Affiliated Committees/Organizations

National Community Action Foundation
1 Massachusetts Avenue, NW
Suite 310
Washington, DC 20001
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Kellie Baker
1 Massachusetts Avenue, NW
Suite 310
Washington, DC 20001
Title: Director of Admin
Phone # (202) 842-2092

Treasurer:

Catherine Hoskins
764 South 200 West
Salt Lake City, Utah 84101
Title: Treasurer
Phone # (202) 842-2092

Designated Agent(s):

Banks or Depositories

Bank of America, N.A.
P.O. Box 25118
Tampa, Florida 336225118

Signed: David Bradley
Date Signed: 04/21/2009

(End FEC FORM 1)

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