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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-849726

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1. 1ST SOURCE CORPORATION POLITICAL ACTION COMMITTEE

    P O BOX 1602
    SOUTH BEND, IN 46634
    Email: Wood@1stsource.com;ShortA@1stsource.com

2. Date: 01/25/2013

3. FEC Committee ID #: C00181529 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

1st Source Corporation
P. O. Box 1602
South Bend, Indiana 46634
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Andrea G. Short
1st Source Bank
P. O. Box 1602
South Bend, IN 46634
Title: Custodian
Phone # (574) 235-2348

Treasurer:

Andrea G. Short
1st Source Bank
P. O. Box 1602
South Bend, Indiana 46634
Title: Treasurer
Phone # (574) 235-2348

Designated Agent(s):

Lori Jean
1st Source Bank
PO Box 1602
South Bend, Indiana 46634
Title: Secretary
Phone # (574) 235-2714

Banks or Depositories

1st Source Bank
P.O. Box 1602
South Bend, Indiana 46634

Signed: Andrea G. Short
Date Signed: 01/25/2013

(End FEC FORM 1)

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