FEC Form 1 for Brown & Williamson Tobacco Corporation Employee Political Action CommitteeForm 1 for Brown & Williamson Tobacco Corporation Employee Political Action Committee

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-136893

1. Brown & Williamson Tobacco Corporation Employee Political Action Committee

P. O. Box 718
Winston-Salem, NC 27102

NOTE: Address is different than previously reported

Fax: 336-741-1205
Email: tompsor@rjrt.com

2. Date: 10/04/2004

3. FEC Committee ID #: C00087791 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

RJR POLITICAL ACTION COMMITTEE; REYNOLDS AMERICAN INC.
P. O. BOX 718
WINSTON-SALEM, North Carolina 27102
Relationship: AFFILIATED PAC
Organization Type: Corporation

Custodian of Records:

Judy Albert
P. O. Box 718
Winston-Salem, NC 27102
Title: Legislative Policy &
Phone # (336) 741-1285

Treasurer:

Randolph C. Tompson
P. O. Box 718
Winston-Salem, North Carolina 27102
Title: Senior Director
Phone # (336) 741-7287

Designated Agent(s):

Randolph Tompson
P. O. Box 718
Winston-Salem, North Carolina 27102
Title: Treasurer
Phone # (336) 741-7287

Banks or Depositories

NATIONAL CITY BANK OF KENTUCKY
P. O. BOX 36000
LOUISVILLE, Kentucky 402336000

Signed: Randolph C. Tompson
Date Signed: 10/04/2004
Official Committee FAX: 336-741-1205

FORM TEXT

(End FEC FORM 1)

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