FEC Form 1 for MOTORISTS MUTUAL INSURANCE COMPANY CIVIC FUNDForm 1 for MOTORISTS MUTUAL INSURANCE COMPANY CIVIC FUND

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-934835

1. MOTORISTS MUTUAL INSURANCE COMPANY CIVIC FUND

471 E BROAD ST
COLUMBUS, OH 43215
Email: paula.hart@motoristsgroup.com;chuck.gaskill@motoristsgroup.com

NOTE: Email address is different than previously reported

2. Date: 07/08/2014

3. FEC Committee ID #: C00336834 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

Committee ID# C00336834
MOTORISTS MUTUAL INSURANCE COMPANY CIVIC FUND
471 E BROAD ST
COLUMBUS, Ohio 43215
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Charles R. Gaskill
1425 Briarmeadow Dr.
Columbus, OH 43235
Title: Secretary
Phone # (614) 225-8593

Treasurer:

Mrs. Susan E. Haack
7494 Heffley Court
Canal Winchester, Ohio 43110
Title: Treasurer
Phone # (614) 225-8691

Designated Agent(s):

Charles R. Gaskill
1425 Briarmeadow Dr.
Columbus, Ohio 43235
Title: Secretary
Phone # (614) 225-8593

Banks or Depositories

PNC Financial Services Group, Inc.
One Financial Parkway
Kalamazoo, Michigan 49009

Signed: Mrs. Susan E. Haack
Date Signed: 07/08/2014
Official Committee URL: www.motoristsgroup.com

(End FEC FORM 1)

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