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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-275133

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1. Headwaters Incorporated PAC

    10653 S. River Front Parkway
    Suite 300
    South Jordan, UT 84095
    Fax: 8019849410
    Email: jward@headwaters.com

2. Date: 07/14/2003

3. FEC Committee ID #: C00388751 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

Headwaters Inc.
10653 S River Front Parkway
Suite 300
South Jordan, Utah 84095
Relationship: Connected
Organization Type: Corporation

Custodian of Records:

Mr. John N. Ward
920 W. Bloomsbury
Murray, UT 84123
Title: VP/Headwaters Inc.
Phone # (801) 984-9400

Treasurer:

Mr. John N. Ward
920 W. Bloomsbury
Murray, Utah 84123
Title: VP/Headwaters Inc.
Phone # (801) 984-9400

Designated Agent(s):

Banks or Depositories

Zions First National Bank
125 West 10600 South
Sandy, Utah 84070

Wells Fargo Bank NA
834 East 9400 South
Sandy, Utah 84094

Signed: Mr. John N. Ward
Date Signed: 02/01/2007
Official Committee FAX: 8019849410

(End FEC FORM 1)

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