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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-775301

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1. Commonwealth-Altadis, Inc. Employee PAC

    5900 N Andrews Ave
    Suite 1100
    Fort Lauderdale, FL 33309

    NOTE: Address is different than previously reported

    Email: hattie.hines@us.imptob.com

    NOTE: Email address is different than previously reported

2. Date: 04/12/2012

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

Affiliated Committees/Organizations

Commonwealth-Altadis, Inc.
5900 N Andrews Ave.
Suite 1100
Fort Lauderdale, Florida 33309
Affiliated Relationship Code: Affiliated Committee

Custodian of Records:

Treasurer:

Hines Hattie
5900 N Andrews Ave
Suite 1100
Fort Lauderdale, fL 33309
Title: Sr. Legal Administra
Phone # (954) 772-9000

Designated Agent(s):

Hattie Hines
5900 N Andrews Ave.
Suite 1100
Fort Lauderdale, Florida 33309
Title: Sr. Legal Administra
Phone # (954) 772-9000

Banks or Depositories

South Central Bank
Lehman Avenue
Bowling Green, Kentucky 42101

Signed: Hines Hattie
Date Signed: 04/12/2012

FORM TEXT

(End FEC FORM 1)

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