FEC FORM 1
STATEMENT OF ORGANIZATION
FILING FEC-847570
1. NCR CORPORATION POLITICAL ACTION COMMITTEE (NCRPAC)
20 F Street, N,W.7th Floor
Washington, DC 20001
NOTE: Address is different than previously reported
Email: Elise.Kirban@ncr.com2. Date: 01/17/2013
3. FEC Committee ID #: C00324103 This committee is a separate segregated fund. Its connected organization is a CorporationIn addition, this committee is a Lobbyist/Registrant PAC.
Affiliated Committees/Organizations
Committee ID# C00324103NCR Corporation
2651 Satellite Blvd
Duluth, Georgia 30096
Affiliated Relationship Code: Connected Organization
Custodian of Records:
Patricia Toker20 F Street, NW
7th Floor
Washington, DC 20001
Title: PAC Manager
Phone # (202) 507-6230
Treasurer:
Tim Heffernan20 F Street, NW
7th Floor
Washington, DC 20001
Title: Treasurer
Phone # (516) 810-0453
Designated Agent(s):
Patricia Toker20 F Streeet, NW
7th Floor
Washington, DC 20001
Phone # (202) 507-6230
Banks or Depositories
JPMorgan Chase100 East Broad Street Floor 11
Columbus, Ohio 43215