FEC Form 1 for SHELTER MUTUAL INSURANCE COMPANY FEDERAL PACForm 1 for SHELTER MUTUAL INSURANCE COMPANY FEDERAL PAC

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-266088

1. SHELTER MUTUAL INSURANCE COMPANY FEDERAL PAC

1817 WEST BROADWAY
COLUMBIA, MO 65218
Fax: 5734465730
Email: swoodbury@shelterinsurance.com

2. Date: 12/19/2006

3. FEC Committee ID #: C00140384 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

Shelter Mutual Insurance Company
1817 West Broadway
Columbia, Missouri 652180001
Relationship: Connected
Organization Type: Corporation W/O Capital Stock

Custodian of Records:

L. GERALD BROOKS
1817 WEST BROADWAY
COLUMBIA, MO 652180001
Title: Treasurer
Phone # (573) 214-4209

Treasurer:

L. GERALD BROOKS
1817 WEST BROADWAY
COLUMBIA, Missouri 652180001
Title: Treasurer
Phone # (573) 214-4209

Designated Agent(s):

Banks or Depositories

Shelter Insurance Federal Credit Union
1817 West Broadway
Columbia, Missouri 652180001

Signed: L. GERALD BROOKS
Date Signed: 12/19/2006
Official Committee FAX: 5734465730

(End FEC FORM 1)

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