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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-883779

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1. LIQUID ROBOTICS INC POLITICAL ACTION COMMITTEE (LIQUID ROBOTICS PAC)

    LIQUID ROBOTICS
    1329 MOFFETT PARK DR
    SUNNYVALE, CA 94089
    Email: doug.carlen@liquidr.com

    NOTE: Email address is different than previously reported

2. Date: 08/01/2013

3. FEC Committee ID #: C00521765 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

Liquid Robotics, Inc.
1329 Moffett Park Dr.
Sunnyvale, California 94089
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Doug Carlen
1329 Moffett Park Dr.
Sunnyvale, CA 94089
Title: Custodian of Records
Phone # (408) 636-4200

Treasurer:

Doug Carlen
1329 Moffett Park Dr.
Sunnyvale, California 94089
Title: Treasurer
Phone # (408) 636-4200

Designated Agent(s):

Sandy McVey
1329 Moffet Park Drive
Sunnyvale, California 94089
Title: Assistant Treasurer
Phone # (408) 636-4200

Banks or Depositories

Wells Fargo N.A.
121 South Market St.
San Jose, California 95113

Signed: Doug Carlen
Date Signed: 08/01/2013

(End FEC FORM 1)

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