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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1228813

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1. AHOLD DELHAIZE USA, INC POLITICAL ACTION COMMITTEE

    NOTE:Commmittee Name is different than previously reported

    PO BOX 1330
    2110 EXECUTIVE DRIVE
    SALISBURY, NC 28145
    Email: Jennifer.Gardner@RetailBusinessServices.com,Teross.Young@RetailBusinessServices.com

    NOTE: Email address is different than previously reported

2. Date: 05/03/2018

3. FEC Committee ID #: C00214304 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

Ahold Delhaize USA, Inc.
P.O. Box 1330
Salisbury, North Carolina 281451330
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Teross Willievick Young
PO Box 1330
Salisbury, NC 28145
Title: Custodian of Records
Phone # (704) 633-8250

Treasurer:

TEROSS WILLIEVICK YOUNG
PO Box 1330
2110 Executive Drive
Salsibury, North Carolina 28145
Title: Treasurer
Phone # (704) 633-8250

Designated Agent(s):

Jennifer Gardner
P.O. Box 1330
Salisbury, North Carolina 281451330
Title: Government Affairs M
Phone # (703) 633-8250

Banks or Depositories

Wells Fargo Bank, N.A.
P.O. Box 63020
San Francisco, California 94163

Signed: TEROSS WILLIEVICK YOUNG
Date Signed: 05/03/2018

FORM TEXT-1

(End FEC FORM 1)

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