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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-755940

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1. Santa Clara County Democratic Club

    5974 Friar Way
    San Jose, CA 95129
    Email: herb@hengstrom.net

2. Date: 12/28/2011

3. FEC Committee ID #: C00419028

This committee supports/opposes more than one Federal candidate and is NOT a separate segregated fund or a party committee.

Affiliated Committees/Organizations

Custodian of Records:

Dr. Herbert Leonard Engstrom
5974 Friar Way
San Jose, AR 95129
Title: Treasurer
Phone # (408) 446-1609

Treasurer:

Herbert Engstrom
5974 Friar Way
San Jose, California 95129
Title: Treasurer
Phone # (408) 446-1609

Designated Agent(s):

Banks or Depositories

Washington Mutual Bank
1725 Saratoga Ave.
San Jose, California 95129

US Bank
1550 El Paseo de Saratoga
San Jose, California 95130

Signed: Dr. Herbert Leonard Engstrom
Date Signed: 12/28/2011
Official Committee URL: www.democraticclub-scc.org

(End FEC FORM 1)

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