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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-40216

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1. American Republic Insurance Company PAC

    601 6th Avenue
    Des Moines, IA 50334
    Email: aricpac@aric.com

2. Date: 06/29/2002

3. FEC Committee ID #: C00367524 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

Custodian of Records:

Barbara L Waymire
601 6th Avenue
Des Moines, IA 50334
Title: Assoc Vice President
Phone # (515) 245-2069

Treasurer:

Barbara L Waymire
601 6th Avenue
Des Moines, Iowa 50334
Title: Assoc Vice President
Phone # (515) 245-2069

Designated Agent(s):

Banks or Depositories

Wells Fargo Bank Iowa NA
666 Walnut St
Des Moines, Iowa 503040837

Signed: Barbara L Waymire
Date Signed: 06/29/2002

(End FEC FORM 1)

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