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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-409247

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1. NCR CORPORATION POLITICAL ACTION COMMITTEE (NCRPAC)

    700 13th Street, N.W. Suite 260
    Washington, DC 20005
    Email: Elise.Kirban@ncr.com

2. Date: 03/23/2009

3. FEC Committee ID #: C00324103 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

Committee ID# C00324103
NCR Corporation
1700 South Patterson Blvd.
Dayton, Ohio 45479
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Patricia Toker
700 13th Street, N.W. Suite 260
Washington, DC 20005
Title: PAC Manager
Phone # (202) 777-9281

Treasurer:

Tim Heffernan
700 13th Street, N.W. Suite 260
Washington, DC 20005
Title: Treasurer
Phone # (516) 810-0453

Designated Agent(s):

Patricia Toker
700 13th Street, N.W. Suite 260
Washington, DC 20005
Phone # (202) 777-9281

Banks or Depositories

JPMorgan Chase
100 East Broad Street Floor 11
Columbus, Ohio 43215

Signed: Tim Heffernan
Date Signed: 03/23/2009

(End FEC FORM 1)

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