FEC Form 1 for GENTEX CORPORATION POLITICAL ACTION COMMITTEE; THEForm 1 for GENTEX CORPORATION POLITICAL ACTION COMMITTEE; THE

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-727388

1. GENTEX CORPORATION POLITICAL ACTION COMMITTEE; THE

PO BOX 315
CARBONDALE, PA 18407

NOTE: Address is different than previously reported

Email: szawislak@gentexcorp.com

NOTE: Email address is different than previously reported

2. Date: 12/30/2010

3. FEC Committee ID #: C00386128 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

Committee ID# C00386128
GENTEX CORPORATION POLITICAL ACTION COMMITTEE; THE
PO BOX 315
CARBONDALE, Pennsylvania 18407
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Lee A Spaulding
34 Hidden Brook Drive
Honesdale, PA 18431

Treasurer:

Stephen Zawislak
118 FOX RUN CIRCLE
Clarks Summit, Pennsylvania 18411
Title: Product Manager
Phone # (570) 282-8336

Designated Agent(s):

Banks or Depositories

PNC Bank
47 S Main Street
Carbondale, Pennsylvania 18407

Signed: Stephen Zawislak
Date Signed: 05/04/2011
Official Committee URL: www.gentexcorp.com

(End FEC FORM 1)

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