FEC Form 1 for MICHIGAN FARM BUREAU POLITICAL ACTION COMMITTEEForm 1 for MICHIGAN FARM BUREAU POLITICAL ACTION COMMITTEE

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-792475

1. MICHIGAN FARM BUREAU POLITICAL ACTION COMMITTEE

7373 W. SAGINAW HIGHWAY
P.O. BOX 30960
LANSING, MI 489177900
Email: SBLACK@MICHFB.COM

2. Date: 06/27/2012

3. FEC Committee ID #: C00096362 This committee is a separate segregated fund. Its connected organization is a Membership Organization
In addition, this committee is a Lobbyist/Registrant PAC.

Affiliated Committees/Organizations

MICHIGAN FARM BUREAU
7373 WEST SAGINAW
LANSING, Michigan 48917
Affiliated Relationship Code: Connected Organization

Custodian of Records:

RYAN M HOLBROOK
7373 WEST SAGINAW HIGHWAY
PO BOX 30960
LANSING, MI 489098460
Title: DIR OF FINANCIAL SVC
Phone # (517) 323-7000

Treasurer:

SCOTT PIGGOTT
7373 W SAGINAW HWY
BOX 30960
LANSING, Michigan 48909
Title: TREASURER
Phone # (517) 323-7000

Designated Agent(s):

SARAH BLACK
7373 W SAGINAW
LANSING, Michigan 48917
Title: ASSISTANT TREASURER
Phone # (517) 323-7000

Banks or Depositories

FARM BUREAU FAMILY CREDIT UNION
P.O. BOX 30960
LANSING, Michigan 489098460

Signed: SCOTT PIGGOTT
Date Signed: 06/27/2012

(End FEC FORM 1)

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