FEC Form 1 for Tyco International (US) Inc. Employees Political Aciton CommitteeForm 1 for Tyco International (US) Inc. Employees Political Aciton Committee

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-217466

1. Tyco International (US) Inc. Employees Political Aciton Committee

9 Roszel Road
Princeton, NJ 08540

2. Date: 05/04/2006

3. FEC Committee ID #: C00113753 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

Tyco International (US) Inc.
9 Roszel Road
Princeton, New Jersey 08540
Relationship: Connected
Organization Type: Corporation

Custodian of Records:

Ms. Cresta Heltemes
Political Action Committee Service
7700 Old Branch Avenue Suite D-103
Clinton, MD 20735
Title: Custodian of Records
Phone # (301) 868-1888

Treasurer:

Mr. C.A. (John) Davidson
9 Roszel Road
Princton, New Jersey 08540
Title: Treasurer
Phone # (609) 720-4200

Designated Agent(s):

Kathy Cahill
9 Roszel Road
Princeton, New Jersey 08540
Title: Assistant Treasurer
Phone # (609) 720-4200

Banks or Depositories

Bank of America
7810 Old Branch Avenue
Clinton, Maryland 20735

Signed: Mr. C.A. (John) Davidson
Date Signed: 05/04/2006

(End FEC FORM 1)

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