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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-751796

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1. Wakefern Food Corp. Political Action Committee

    33 Northfield Avenue
    Edison, NJ 08818
    Email: administrator@wakepac.org

    NOTE: Email address is different than previously reported

2. Date: 11/04/2011

3. FEC Committee ID #: C00489005 This committee is a separate segregated fund. Its connected organization is a Corporation
     In addition, this committee is a Lobbyist/Registrant PAC.

Affiliated Committees/Organizations

Wakefern Food Corp.
5000 Riverside Drive
Keasbey, New Jersey 08832
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Jay Edmondson
33 Northfield Avenue
Edison, NJ 08818
Title: Asst. Treasurer
Phone # (732) 906-5328

Treasurer:

Douglas Wille
5000 Riverside Drive
Keasbey, New Jersey 08832
Title: Treasurer
Phone # (732) 512-6374

Designated Agent(s):

Jay Edmondson
33 Northfield Avenue
Edison, New Jersey 08818
Title: Asst. Treasurer
Phone # (732) 906-5328

Banks or Depositories

Bank of America
750 Walnut Avenue, 3rd Floor
Cranford, New Jersey 07016

Signed: Douglas Wille
Date Signed: 11/03/2011

(End FEC FORM 1)

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