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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-730419

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1. HEINEKEN USA INC GOOD GOVERNMENT COMMITTEE

    360 Hamilton Avenue
    White Plains, NY 10601
    Email: hggf@heinekenusa.com

2. Date: 06/02/2011

3. FEC Committee ID #: C00358234 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

Heineken USA Inc.
360 Hamilton Avenue
White Plains, New York 10601
Affiliated Relationship Code: Connected Organization

Custodian of Records:

T. Daniel Tearno
360 Hamilton Avenue
White Plains, NY 10601
Title: SVP Chief CR Ofcr
Phone # (914) 681-4113

Treasurer:

T. Daniel Tearno
360 Hamilton Avenue
White Plains, New York 10601
Title: SVP Chief CR Ofcr
Phone # (914) 681-4113

Designated Agent(s):

Bridget Degroot
360 Hamilton Avenue
White Plains, New York 10601
Title: Assistant Treasurer
Phone # (914) 461-1548

Banks or Depositories

Chase Manhattan Bank
106 Corporate Park Drive
White Plains, New York 10604

Signed: T. Daniel Tearno
Date Signed: 06/02/2011

(End FEC FORM 1)

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