FEC Form 1 for CUNA Mutual Insurance Society Political Action Committee (CUNA Mutual PAC)Form 1 for CUNA Mutual Insurance Society Political Action Committee (CUNA Mutual PAC)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-261846

1. CUNA Mutual Insurance Society Political Action Committee (CUNA Mutual PAC)

5910 Mineral Point Rd PO Box 747
Mail Stop 5910 4 A2
Madison, WI 537010747

NOTE: Address is different than previously reported

Fax: 6082368684
Email: christopher.roe@cunamutual.com

2. Date: 12/05/2006

3. FEC Committee ID #: C00402107 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Christopher P. Roe
2 Hawk Feather Cir
Madison, Wisconsin 53717
Title: SVP Corp & Legis Aff
Phone # (608) 231-8684

Designated Agent(s):

Banks or Depositories

Signed: Christopher P. Roe
Date Signed: 12/05/2006
Official Committee FAX: 6082368684

(End FEC FORM 1)

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