NCC202992_Contact Update Record (Address Change Only)_20220118

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Georgoulias, Bethany A 1/18/2022 10:53:03 AM (Contact Changes Submitted)

Certificate of NCC202992
Coverage (COC) No.* Enter the Certificate of Coverage Number (Use capital letters)
NC Reference No. NCG01-2020-2992
Original NOI No.* 28202
Project information associated with this permit (cannot change):
Permittee Listed Organizaiton cannot be changed (new COC required)
Pee Dee Electric Membership Corporation
Project Name Pee Dee Electric
Address Vintage Road, Lilesville, NC
County Anson
Latitude 34.9526
Longitude-79.9058
Date COC Issued * 07/16/2020
Prior Rescission Date This field will populate only if COC has already been rescinded.
Which Contacts Have Billing Only
Changed?* • Legally Responsible Individual Only
Site Contact Only
BOTH Legally Responsible Individual and Site Contact
Has Billing Contact Choose'Yes'to revise Billing Contact details.
Changed? U No
Yes
Billing Email
NEW Billing Email [e-mail]
Billing Telephone No.
NEW Billing [phone]
Telephone No. (Optional)
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible Donnie Spivey
Individual (Previous)
First Name (New)* Donnie
Last Name (New) * Spivey

NEW Legally Reflects any revisions above
Responsible Donnie Spivey
Individual*
Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee Telephone [phone]
No. (Previous)
NEW Permittee [phone]
Telephone No.*
Permittee Mailing 575 U.S. 52, 0, Wadesboro, NC 28170-6467
Address (Previous)
NEW Permittee Street Address
Mailing Address* 9825 US Hwy 74 East
Address Line 2
City
State / Province / Region
Lilesville
NC
Postal / Zip Code
Country
28091
US
Permittee Street 575 U.S. 52, 0, Wadesboro, NC 28170-6467
Address (Previous)
NEW Permittee Street Street Address
Address* 9825 US Hwy 74 East
Address Line 2
City State / Province / Region
Lilesville NC
Postal / Zip Code Country
28091 US
Change Requested Anthony Eason via Modification Request submitted 1/14/2022; confirmed via email
by: * on 1 /18/2022.
Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation Mailing/Street address change only.
(Optional)
Date * 01 /18/2022