FEC Form 1 for WIN-PAC of Winn-Dixie Stores Inc.Form 1 for WIN-PAC of Winn-Dixie Stores Inc.

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-103749

1. WIN-PAC of Winn-Dixie Stores Inc.

NOTE:Commmittee Name is different than previously reported

5050 Edgewood Court
Jacksonville, FL 32254
Email: KariWeber@winn-dixie.com

2. Date: 01/16/2004

3. FEC Committee ID #: C00033092 This committee is a Principal Campaign Committee. Candidate:
Party: National
Office Sought:
State is in District:

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Jeffrey Gleason
5050 Edgewood Court
Jacksonville, Florida 32254
Title: Treasurer

Designated Agent(s):

Banks or Depositories

Signed: Jeffrey Gleason
Date Signed: 01/16/2004

(End FEC FORM 1)

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