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IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD Form
VERIFIED STATEMENT
510 EAST 12th, SUITE 1A RitM FWW REGISTRATION
DES MOINES, IA 50319 (Out-of-State Committees)
` % www.iowa.gov/ethic s (Rev . 07103)
.̀.
` VERIFIED STATEMENT REGISTRATION For office use only
(Out-of-State Committee) Comm . #

0 COMMITTEES NOT ORGANIZED IN IOWA TO COMPLETE IN DUPLICATE .

Indexed
Audited
SEND A COPY TO THE BOARD WITHIN 15 DAYS OF THE CONTRIBUTION DATE AND
ONE COPY WITH EACH CONTRIBUTION TO THE IOWA COMMITTEE WITH THE CONTRIBUTION . Checked
PLEASE REFER TO DETAILED INSTRUCTIONS ON BACK OF FORM . Computer
THIS FORM MUST BE FILED FOR EACH CONTRIBUTION IN EXCESS OF $50

COMMITTEE NAME
Official Name of Out-of-State Committee (Do not abbreviate committee name . Written explanation must be provided for Acronym) .
Regi ons Financial Corporation Committee on Government Affairs (Regions COGA)
Mailing Address
Post Office Box 10247
I No .
Birmingham, ALC%A!te,
Zip Code ,~BS Cole 244-29 5 phone

STATE OR FEDERAL JURISDICTION WHERE COMMITTEE PARENT ENTITY, AFFILIATE, SPONSOR OF COMMITTEE
IS REGISTERED OR OPERATES (Use separate page if needed to list more than one entity)

Name of Jurisdiction Name

Federal Election Co Regions Financial Corporation
Mailing Address Mailing Address
999 E Street, NW PO Box 10247
Tele State, Zip Code
as'W*412, b0e 20463 694-1100 Birmingham, AL 352VY'

PURPOSE OF COMMITTEE

Regions COGA is a qualified, non-party committee registered with the Federal Elections Commission

(Committee ID: 000179473) with a purpose to perform all activities permitted by state and federal law for such

committees .

IOWA RESIDENT AGENT IOWA COMMITTEE RECEIVING CONTRIBUTION

Typed Name of Iowa Resident Name of Committee
Tom Killeen
~p_fy 0 (~O Ca~ 1N^

Ion
Mailing Address Mailing Add r ss
3334 WESTOWN PARKWAY fo Bo x. W G 4-(w 145-070
City, State, Zip Code Telephone Date If In-Kind Contribution, Describe
WEST DES MOINES, IA 50266 5155 1 235-8350 S17 Ids /1/4
Amount p o Check # I Committee . ID #
$ 200

D STATEMENT OF COMMITTEE:

1 'Jow I ta'~ attest that the contribution reported above is accurate and that the information about this out-of-state
committee is correct and accurate to the best of nowledge. 1 also attest that the reports filed in the named jurisdiction comply with requirements that are
substantially similar to Iowa Code section 68, cluding the disclosure of all contributions received and all expenditures made. l further attest that the
contribution reported above was made f% ount that does not accept contributions from corporations or other prohibited contributors under Iowa Code
r
section 68815;-nnlecq f ow recipi~ e is a ballot issue committee. 1 understand that potential civil and criminal penalties may apply unless a copy of
thi ampaign Disclosure Board within 15 days of the date of the contribution

(Title) (Date)