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-443928

1. AMERICANS FOR DEMOCRATIC ACTION INC POLITICAL ACTION COMMITTEE

1625 K STREET NW SUITE 210
WASHINGTON, DC 20006
Email: dkusler@adaction.org

NOTE: Email address is different than previously reported

2. Date: 01/07/2010

3. FEC Committee ID #: C00112680 This committee is a separate segregated fund. Its connected organization is a Membership Organization

Affiliated Committees/Organizations

Americans for Democratic Action, Inc
1625 K Street, NW, #210
Washington, DC 20006
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Don Kusler
14724 Jarnigan Street
Centreville, VA 20120
Phone # (202) 785-5980

Treasurer:

Don Kusler
14724 Jarnigan Street
Centreville, Virginia 20120
Title: Acting Treasurer
Phone # (202) 785-5980

Designated Agent(s):

Banks or Depositories

Adams National Bank
1501 K Street, NW
Washington, Delaware 20005

Signed: Don Kusler
Date Signed: 01/07/2010

(End FEC FORM 1)

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