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FEC Form 1 for Great West Casualty Company Employee & Agent PACForm 1 for Great West Casualty Company Employee & Agent PAC

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-417248


1. Great West Casualty Company Employee & Agent PAC

    P.O. Box 277
    South Sioux City, NE 68776

    NOTE: Address is different than previously reported

    Email: k.myers@gwccnet.com

    NOTE: Email address is different than previously reported

2. Date: 05/14/2009

3. FEC Committee ID #: C00326496 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

Committee ID# C00326496
Great West Casualty Company Employee & Agent PAC
P.O. Box 277
South Sioux City, Nebraska 68776
Affiliated Relationship Code: Connected Organization

Custodian of Records:

David R. Parker
P.O. Box 277
South Sioux City, NE 68776
Title: Treasurer
Phone # (402) 494-2411

Treasurer:

David R. Parker
P.O. Box 277
South Sioux City, Nebraska 68776
Title: Treasurer
Phone # (402) 494-2411

Designated Agent(s):

Banks or Depositories

Siouxland National Bank
P.O. Box 987
South Sioux City, Nebraska 687760987

Signed: David R. Parker
Date Signed: 05/14/2009

(End FEC FORM 1)


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