FEC Form 1 for Nationwide Mutual Insurance Company Iowa Political Action CommitteeForm 1 for Nationwide Mutual Insurance Company Iowa Political Action Committee

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-385094

1. Nationwide Mutual Insurance Company Iowa Political Action Committee

1100 Locust
DM-01-0301
Des Moines, IA 503910301
Fax: 6142493073
Email: bearins@nationwide.com

2. Date: 11/18/2008

3. FEC Committee ID #: C00123976 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

Committee ID# C00123976
Nationwide
One Nationwide Plaza
Columbus, Ohio 43215
Affiliated Relationship Code: Connected Organization

Nationwide Mutual Insurance Company Po
One Nationwide Plaza
1-27-10
Columbus, Ohio 43215
Affiliated Relationship Code: Affiliated Committee

Nationwide Mutual Insurance Company an
1601 Exposition Blvd; PC1A
Sacramento, California 95815
Affiliated Relationship Code: Affiliated Committee

Custodian of Records:

Shannon Bearinger
One Nationwide Plaza
Columbus, OH 43215
Title: Custodian of Records
Phone # (614) 249-5470

Treasurer:

Randall Kramer
1100 Locust Street
Des Moines, Iowa 50391
Title: Treasurer
Phone # (515) 508-4850

Designated Agent(s):

Banks or Depositories

Wells Fargo
666 Walnut Street
Des Moines, Iowa 50309

Signed: Mr. Randall Kramer
Date Signed: 11/18/2008
Official Committee FAX: 6142493073

(End FEC FORM 1)

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