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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-841395

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1. Nancy Pelosi Victory Fund

    430 South Capitol Street, SE
    Washington, DC 20003
    Email: forte@dccc.org

2. Date: 12/10/2012

3. FEC Committee ID #: C00492421

This committee is an independent expenditure-only political committee (Super PAC).

Affiliated Committees/Organizations

NONE
, ____

Custodian of Records:

Kelly C. Ward
430 South Capitol Street, SE
2nd Floor
Washington, DC 20003
Title: Treasurer

Treasurer:

Kelly C. Ward
430 South Capitol Street, SE
2nd Floor
Washington, DC 20003
Title: Treasurer

Designated Agent(s):

Jacqueline Forte-Mackay
430 South Capitol Street, SE
2nd Floor
Washington, DC 20003
Title: Assistant Treasurer

Banks or Depositories

Bank of America, N.A.
730 15th Street, NW
Washington, DC 20005

Signed: Kelly C. Ward
Date Signed: 12/10/2012

(End FEC FORM 1)

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