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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-490581

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1. MISSOURI FARM BUREAU FARM PAC, NORTHWEST DISTRICT

    506 Macadee Street
    Maysville, MO 64469

    NOTE: Address is different than previously reported

    Email: ronald298@centurytel.net

2. Date: 08/26/2010

3. FEC Committee ID #: C00040428 This committee is a separate segregated fund. Its connected organization is a Membership Organization

Affiliated Committees/Organizations

Missouri Farm Bureau Federation
PO Box 658
Jefferson City, Missouri 65102
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Ron Crider
506 Macadee Street
Maysville, MO 64469
Title: Treasurer
Phone # (816) 393-5481

Treasurer:

Ron Crider
506 Macadee Street
Maysville, Missouri 64469
Title: Treasurer
Phone # (816) 393-5481

Designated Agent(s):

Banks or Depositories

Nodaway Valley Bank
PO Box 700
Maryville, Missouri 64468

Signed: Ron Crider
Date Signed: 08/26/2010

(End FEC FORM 1)

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