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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-359113


1. SHELTER MUTUAL INSURANCE COMPANY FEDERAL PAC

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

2. Date: 08/21/2008

3. FEC Committee ID #: C00140384 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

Shelter Mutual Insurance Company
1817 West Broadway
Columbia, Missouri 652180001
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Tina M Workman
1817 West Broadway
Columbia, MO 65218
Title: Treasurer
Phone # (573) 214-4574

Treasurer:

Tina M Workman
1817 West Broadway
Columbia, Missouri 65218
Title: Treasurer
Phone # (573) 214-4574

Designated Agent(s):

Tina M Workman
1817 West Broadway
Columbia, Missouri 65218
Title: Treasurer
Phone # (573) 214-4574

Banks or Depositories

Shelter Financial Bank
1817 West Broadway
Columbia, Missouri 65218

Signed: Tina M Workman
Date Signed: 08/21/2008
Official Committee FAX: 5734465730

(End FEC FORM 1)


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