IOWA ETHICS AND f,.

AMPAIGN DISCLOSURE BOARD Form

,6LLV0V
514 EAST LOCUST, SUITE 104 VERIFIED STATEMENT
REGISTRATION
DES MOINES, IA 50309-1912 (Out-of-State Committees)
(Rev . 11 /00)

VERIF~E STATEMENT REGISTRATION For office use onl

2004 (Out-of-State Committee) Comm . #

Indexed
COMMITTEE$ NOT ORGANIZED IN IOWA TO COMPLETE IN DUPLICATE.
SEND ORIGINAL COPY TO THE BOARD AND Audited
';&&,CQPY WITH EACH CONTRIBUTION TO THE IOWA COMMITTEE. Checked
PLEASE REFER TO DETAILED INSTRUCTIONS ON BACK OF FORM.
Computer
COMMITTEE NAME

Official Name of Out-of-State Committee (Do not abbreviate committee name . Written explanation must be provided for Acronym.)
Union Plan e rs Corporation Committee nn Cnvprnmpnt Affair-
Mailing Address
7130 Goodlett Farms Parkway
City, State, Zip Code Area Code Telephone No .
r "N tan-3Q (901 ) 580-4096

TREASURER OTHER OFFICERS (Attach second page if needed)

Name of Treasurer Name of Chairperson

Linda de 1a Crrtj7 .1pr-ksor.~W Moo
Mail ng Addre s -Mailing Address
7130 Goodlett arms Parkway A3E 7130 Goodlett Farms Parkway A4E
City, State, Zip Code Telephone City, State, Zip Code Telephone
cardava-T# 2O12 "Po 1--689--4996- Cnrndva TN 2Rn1R tnn1 r%Rn_F

IOWA RESIDENT AGENT

PARENT ENTITY, AFFILIATE, SPONSOR OF COMMITTEE
of Iowa Resident Agent
(Use separate page if needed to list more than one entity)
Typed Name of Iowa Resident Name
iJg)i(n Rathi Union Planters Cnrpi-Irntinn
Mailing Address Mailing Address
100 East Park Avenue 7130 Goodlett Farms Parkway
City, State, Zip Code Telephone City, State, Zip Code
Water1nn TA 5n7n3 Cnrndvg, TN 291711R

PURPOSE OF COMMITTEE:

To raise funds for Pnl itical Contrihtiti nns withmrt. rpgarri to Pnrt' nffi l i ati nn

IOWA COMMITTEE RECEIVING CONTRIBUTION

STATE OR FEDERAL JURISDICTION WHERE COMMITTEE ~{ . _
IS REGISTERED OR OPERATES t ~iCl~~
Vl h ~

sl c
r.Hl .
Name of Jurisdiction i
Federal Election Commission
Date ci Ll If In Kind Contribitb. n r1PCrriba ,.
999 E . Street NW
Mailing Address
_W4 l:~l ;t ;r-al CQntfibutio
City, State, Zip Code Telephone Amount +w'
Washingtnn DC. 204153 /0DI
VERIFIED STATEMENT OF COMMITTEE:
I , swear that the contribution reported above is accurate. I further swear that the information about this out-of-
state committee is correct and accurate to the best of my knowledge. I attest that the reports filed in the named jurisdiction comply with requirements which are
substantially similar to Iowa Code section 56 .6, including the disclosure of all contributions received and allexpenditures made . 1 further attest that the contribution
reported above was made from an account, which does not accept contributions from corporations or otherprohibited contributors under Iowa Code section 56 .15.
1 understand that Iowa committees are prohibited from accepting contributions from out-of-state committees unless a signed original of this form has been filed with
the Iowa Ethics and gampaign Disclosure Board, or the out-of-state committee is registered and filing full disclosure reports in Iowa .

/vcb-A 1
(Only Agnatur of r or Chairperson) (Title) (Date)
%
me this day of t tf )L f , 20C0 at, (It-

My notary commission expire s, - 1~ss%~

"
.NOTARY
. PUBLIC
;$ AT T 2
rP :~, !ARGE ;~ "~