FEC Form 1 for NCR CORPORATION POLITICAL ACTION COMMITTEE (NCRPAC)Form 1 for NCR CORPORATION POLITICAL ACTION COMMITTEE (NCRPAC)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-869058

1. NCR CORPORATION POLITICAL ACTION COMMITTEE (NCRPAC)

20 F Street, N,W.
7th Floor
Washington, DC 20001
Email: patricia.toker@ncr.com

NOTE: Email address is different than previously reported

2. Date: 04/26/2013

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
2651 Satellite Blvd
Duluth, Georgia 30096
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Patricia Toker
20 F Street, NW
7th Floor
Washington, DC 20001
Title: PAC Manager
Phone # (202) 507-6230

Treasurer:

Marija Zivanovic-Smith
20 F Street, NW
7th Floor
Washington, DC 20001
Title: Treasurer
Phone # (202) 507-6234

Designated Agent(s):

Patricia Toker
20 F Street, NW
7th Floor
Washington, DC 20001
Phone # (202) 507-6230

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-869058

1. NCR CORPORATION POLITICAL ACTION COMMITTEE (NCRPAC)

NOTE: Email address is different than previously reported

2. Date: 04/26/2013

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: Timothy M. Heffernan
Date Signed: 04/26/2013

(End FEC FORM 1)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-869058

1. NCR CORPORATION POLITICAL ACTION COMMITTEE (NCRPAC)

NOTE: Email address is different than previously reported

2. Date: 04/26/2013

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: Timothy M. Heffernan Date Signed: 04/26/2013

(End FEC FORM 1)

Signed: Timothy M. Heffernan
Date Signed: 04/26/2013