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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-508121

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1. Grange Mutual Casualty Company PAC

    671 South High Street
    PO Box1218
    Columbus, OH 432161218
    Email: vanvleraha@grangeinsurance.com

    NOTE: Email address is different than previously reported

2. Date: 10/21/2010

3. FEC Committee ID #: C00302695 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

Grange Mutual Casualty Company
671 S. High Street
Columbus, Ohio 43206
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Treasurer:

Andrea B. Van Vlerah
671 South High Street
P.O. Box 1218
Columbus, Ohio 432161218
Title: Executive Legal Assi
Phone # (614) 445-2607

Designated Agent(s):

LaVawn D. Coleman
671 S. High Street
Columbus, Ohio 43206
Title: AVP/General Counsel
Phone # (614) 445-2649

Banks or Depositories

PNC Bank
629 Euclid Avenue
Cleveland, Ohio 44114

Signed: Andrea B. Van Vlerah
Date Signed: 10/21/2010

FORM TEXT

(End FEC FORM 1)

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