FEC Form 1 for Pacific Life Insurance Company Political Action CommitteeForm 1 for Pacific Life Insurance Company Political Action Committee

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-708278

1. Pacific Life Insurance Company Political Action Committee

700 Newport Center Drive
Newport Beach, CA 92660
Email: CSmitski@PacificLife.com

2. Date: 01/25/2011

3. FEC Committee ID #: C00068528 This committee is a separate segregated fund. Its connected organization is a Corporation
In addition, this committee is a Lobbyist/Registrant PAC.

Affiliated Committees/Organizations

Pacific Life Insurance Company
700 Newport Center Drive
Newport Beach, California 92660
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Connie Smitski
700 Newport Center Drive
Newport Beach, CA 92660
Title: GR Coordinator
Phone # (949) 219-3280

Treasurer:

Patricia Douglass
700 Newport Center Drive
Newport Beach, California 92660
Title: Vice President, GR
Phone # (949) 219-3280

Designated Agent(s):

Banks or Depositories

Bank of America
2049 Century Park East
Los Angeles, California 90067

Signed: Patricia Douglass
Date Signed: 01/25/2011

FORM TEXT

(End FEC FORM 1)

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