FEC Form 1 for AMERICANS FOR DEMOCRATIC ACTION INC POLITICAL ACTION COMMITTEEForm 1 for AMERICANS FOR DEMOCRATIC ACTION INC POLITICAL ACTION COMMITTEE

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-136085

1. AMERICANS FOR DEMOCRATIC ACTION INC POLITICAL ACTION COMMITTEE

1625 K STREET NW SUITE 210
WASHINGTON, DC 20006
Fax: 2027855969
Email: adaction@ix.net.com

2. Date: 09/24/2004

3. FEC Committee ID #: C00112680 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

AMERICANS FOR DEMOCRATIC ACTION
1625 K Street
Suite 210
Washington, DC 20006
Relationship: CONNECTED
Organization Type: Membership Organization

Custodian of Records:

Treasurer:

Valerie Dulk Jacobs
1625 K Street
#210
Washington, DC 20006
Title: Treasurer
Phone # (202) 785-5980

Designated Agent(s):

Valerie Dulk Jacobs
1625 K Street
#210
Washington, DC 20006
Title: Directors Assistant
Phone # (707) 785-5980

Amy Issacs
1625 K Street NE
#210
Washington, DC 20006
Title: Director
Phone # (202) 785-5980

Banks or Depositories

Adams National Bank
1501 K Street NW
Washington, Delaware 20005

Signed: Valerie Dulk Jacobs
Date Signed: 09/24/2004
Official Committee URL: www.adaction.org
Official Committee FAX: 2027855969

(End FEC FORM 1)

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