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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-758067

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1. Swedish Match North America, Inc. PAC

    NOTE:Commmittee Name is different than previously reported

    1021 East Cary Street
    Richmond, VA 23219
    Email: melanie.rapp@smna.com

2. Date: 12/19/2011

3. FEC Committee ID #: C00215053 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

SWEDISH MATCH NORTH AMERICA INC
7300 BEAUFONT SPRINGS DRIVE
SUITE 400
RICHMOND, Virginia 23225
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Melanie Rapp
1205 Huntersdell Place
Richmond, VA 23235
Title: Custodian
Phone # (804) 302-1916

Treasurer:

WANDA BLAKE
102 Walton Creek Drive
Midlothian, Virginia 23114
Title: Treasurer
Phone # (804) 302-1712

Designated Agent(s):

Banks or Depositories

BB&T Bank
823 East Main Street
9th Floor
Richmond, Virginia 23219

Wachovia Bank
1021 East Cary Street
PO Box 27602
Richmond, Virginia 23261

Signed: WANDA BLAKE
Date Signed: 01/18/2012

(End FEC FORM 1)

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