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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-745298

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1. MISSOURI FARM BUREAU FARM PAC, SOUTHWEST DISTRICT

    5863 W. State Highway 76
    Anderson, MO 648318129
    Email: mfbpac@mofb.com

    NOTE: Email address is different than previously reported

2. Date: 09/19/2011

3. FEC Committee ID #: C00093898 This committee is a separate segregated fund. Its connected organization is a Membership Organization

Affiliated Committees/Organizations

Missouri Farm Bureau Federation
P. O. 658
Jefferson City, Missouri 65102
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Vance Keaton
5863 W. State Hwy 76
Anderson, MO 648318129
Title: Treasurer

Treasurer:

Vance Keaton
5863 W. State Hwy 76
Anderson, Missouri 648318129
Title: Treasurer

Designated Agent(s):

Banks or Depositories

Hometown Bank
E. 32nd Street
Joplin, Missouri 64803

Signed: Vance Keaton
Date Signed: 09/19/2011

(End FEC FORM 1)

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