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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-751792

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1. C. R. Bard Inc. Active Citizenship Committee

    730 Central Avenue
    Murray Hill, NJ 07974
    Email: fecinfo@pass1.com

    NOTE: Email address is different than previously reported

2. Date: 11/04/2011

3. FEC Committee ID #: C00359125 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

C.R. Bard Inc.
730 Central Avenue
Murray Hill, New Jersey 07974
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Scott Lowry
730 Central Ave.
Murray Hill, NJ 07974
Title: Custodian

Treasurer:

Scott Lowry
730 Central Ave.
Murray Hill, New Jersey 07974
Title: Treasurer
Phone # (908) 277-8265

Designated Agent(s):

Michael Piotrowski
270 Central Avenue
Murray Hill, New Jersey 07974
Title: Assistant Treasurer
Phone # (908) 277-8193

Banks or Depositories

Bank of America
15 South Street
New Providence, New Jersey 07974

Signed: Scott Lowry
Date Signed: 11/04/2011
Official Committee URL: n/a

FORM TEXT

(End FEC FORM 1)

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