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-743097

1. GENTEX CORPORATION POLITICAL ACTION COMMITTEE; THE

PO BOX 315
CARBONDALE, PA 18407
Email: hmacker@gentexcorp.com

NOTE: Email address is different than previously reported

2. Date: 08/23/2011

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
Title: Executive Assistant
Phone # (570) 282-8222

Treasurer:

Heather M Acker
PO Box 573
Waverly, Pennsylvania 18471
Title: CFO
Phone # (570) 282-8224

Designated Agent(s):

Banks or Depositories

PNC Bank
47 S Main Street
Carbondale, Pennsylvania 18407

Signed: Heather M Acker
Date Signed: 08/23/2011

(End FEC FORM 1)

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