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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1111762

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1. Southern Glazer's Wine and Spirits PAC

    NOTE:Commmittee Name is different than previously reported

    1600 NW 163 Street
    Miami, FL 33169
    Email: tammylove@southernwine.com

2. Date: 07/01/2016

3. FEC Committee ID #: C00217877 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

Southern Glazer's Wine and Spirits
1600 NW 163 Street
Miami, Florida 33169
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Tamara Love
1600 NW 163 Street
Miami, FL 33169
Title: Corp Administrator
Phone # (305) 627-1261

Treasurer:

Steven Becker
1600 NW 163 Street
Miami, Florida 33169
Title: Treasurer
Phone # (305) 627-1102

Designated Agent(s):

Banks or Depositories

Bank of America
1401 Elm Street
Dallas, Texas 75202

Signed: Steven Becker
Date Signed: 10/20/2016

(End FEC FORM 1)

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