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

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-438490

1. Fiserv Corp. PAC

4411 E. Jones Bridge Road
Norcross, GA 30092

NOTE: Address is different than previously reported

Email: brendacooper.jones@fiserv.com

NOTE: Email address is different than previously reported

2. Date: 10/30/2009

3. FEC Committee ID #: C00378166 This committee is a separate segregated fund. Its connected organization is a Corporation
In addition, this committee is a Lobbyist/Registrant PAC.

Affiliated Committees/Organizations

Fiserv Corporation
255 Fiserv Drive
Brookfield, Wisconsin 53045
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Brenda C., Jones
4411 E. Jones Bridge Road
Norcross, GA 30092
Title: VP, Public Affairs
Phone # (678) 375-3430

Treasurer:

Brenda C., Jones
4411 E. Jones Bridge Road
Norcross, Georgia 30092
Title: VP, Public Affairs
Phone # (678) 375-3430

Designated Agent(s):

Charles W. Sprague
255 Fiserv Drive
Brookfield, Wisconsin 53045
Title: Assistant Treasurer

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-438490

1. Fiserv Corp. PAC

NOTE: Address is different than previously reported

NOTE: Email address is different than previously reported

2. Date: 10/30/2009

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: Brenda C., Jones
Date Signed: 10/30/2009

(End FEC FORM 1)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-438490

1. Fiserv Corp. PAC

NOTE: Address is different than previously reported

NOTE: Email address is different than previously reported

2. Date: 10/30/2009

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: Brenda C., Jones Date Signed: 10/30/2009

(End FEC FORM 1)

Signed: Brenda C., Jones
Date Signed: 10/30/2009