FEC FORM 1
STATEMENT OF ORGANIZATION
FILING FEC-347076
1. Headwaters Incorporated PAC
10653 S. River Front ParkwaySuite 300
South Jordan, UT 84095
Fax: 8019849410
Email: sballard@headwaters.com
2. Date: 07/03/2008
3. FEC Committee ID #: C00388751 This committee is a separate segregated fund. Its connected organization is a CorporationAffiliated Committees/Organizations
Headwaters Inc.10653 S River Front Parkway
Suite 300
South Jordan, Utah 84095
Affiliated Relationship Code: Connected Organization
Custodian of Records:
Mr. Scott Ballard10653 S River Front Parkway
Suite 300
South Jordan, UT 84095
Title: Treasurer/Headwaters
Phone # (801) 984-9400
Treasurer:
Mr. Scott Ballard10653 S River Front Parkway
Suite 300
South Jordan, Utah 84095
Title: Treasurer/Headwaters
Phone # (801) 984-9400
Designated Agent(s):
Banks or Depositories
Zions First National Bank125 West 10600 South
Sandy, Utah 84070
Wells Fargo Bank, NA
834 East 9400 South
Sandy, Utah 84094