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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-758990

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1. Democracy Engine, Inc., PAC

    850 Quincy Street, NW #402
    Washington, DC 20011

    NOTE: Address is different than previously reported

    Email: pac@democracyengine.com

2. Date: 01/23/2012

3. FEC Committee ID #: C00468314 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

Democracy Engine, Inc.
2125 14th Street NW #101W
Washington, DC 20009
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Jonathan Zucker
850 Quincy Street, NW #402
Washington, DC 20011
Title: Treasurer
Phone # (202) 449-9647

Treasurer:

Jonathan Zucker
850 Quincy Street, NW #402
Washington, DC 20011
Title: Treasurer
Phone # (202) 449-9647

Designated Agent(s):

Banks or Depositories

Citi
1775 Pennsylvania Ave, NW
Washington, DC 20006

Signed: Jonathan Zucker
Date Signed: 01/23/2012

(End FEC FORM 1)

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