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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-745295

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1. MISSOURI FARM BUREAU FARM PAC, SOUTHEAST DISTRICT

    178 David
    Jackson, MO 63755
    Email: mfbpac@mofb.com

    NOTE: Email address is different than previously reported

2. Date: 09/19/2011

3. FEC Committee ID #: C00089839 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:

Dale Steffens
178 David
JACKSON, MO 63755
Title: Treasurer

Treasurer:

Dale Steffens
178 David
JACKSON, Missouri 63755
Title: Treasurer

Designated Agent(s):

Banks or Depositories

MONTGOMERY BANK
PO BOX 710
JACKSON, Missouri 63755

Signed: Dale Steffens
Date Signed: 09/19/2011

(End FEC FORM 1)

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