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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-772524

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1. Commonwealth-Altadis, Inc. Employee PAC

    900 Church Street
    PO Box 51587
    Bowling Green, KY 42101
    Email: yvonne.cowles@us.imptob.com

2. Date: 03/28/2012

3. FEC Committee ID #: C00455600 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

Commonwealth-Altadis, Inc.
900 Church Street
Bowling Green, Kentucky 42101
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Treasurer:

Hines Hattie
900 Church Street
Bowling Green, Kentucky 42101
Title: Administrative Assis
Phone # (270) 781-9100

Designated Agent(s):

Yvonne Cowles
PO Box 51587
900 Church Street
Bowling Green, Kentucky 42101
Title: Legal Compliance Sup
Phone # (270) 781-9100

Banks or Depositories

South Central Bank
Lehman Avenue
Bowling Green, Kentucky 42101

Signed: Hines Hattie
Date Signed: 03/28/2012

FORM TEXT

(End FEC FORM 1)

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