FEC Form 1 for Fiserv Corp. PACForm 1 for Fiserv Corp. PAC

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-312828

1. Fiserv Corp. PAC

NOTE:Commmittee Name is different than previously reported

255 Fiserv Drive
Brookfield, WI 530080979

NOTE: Address is different than previously reported

Email: bjones@checkfree.com

2. Date: 12/13/2007

3. FEC Committee ID #: C00378166 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

Fiserv Corporation
255 Fiserv Drive
Brookfield, Wisconsin 53045
Relationship: connected
Organization Type: Corporation

Committee ID# C00399949
None
5500 Wayzata Blvd
Suite 500
Minneapolis, Minnesota 55416
Relationship: affiliate

Custodian of Records:

Treasurer:

Ms. Brenda Jones
25 Howell Mill Plantation
Atlanta, Georgia 30327

Designated Agent(s):

Banks or Depositories

Signed: Ms. Brenda Jones
Date Signed: 12/13/2007

FORM TEXT

(End FEC FORM 1)

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