NCC230231_FRO Submitted_20230126

FINANCIAL RESPONSIBILITYIOWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
No person may Initiate any land -disturbing activity on more than1.0 acres as covered by the Act before this form and
an acceptable erosion and sedimentation control plan have been completed and approved by the Town of
Waddington. Submit this form to. 1924 Waddington Road, Waddington, NC 28104. (Please type or print and, If the
question is not applicable or the e-mail and/or fax information unavailable, place N/A In the blank.)
Part A.
1. Project
2. Location of land -disturbing activity: CountY_Ubf`0_0 City or Township LVA4,Ckyl
Highway/Street 8131 c d< Latitudes, 4SS Cy Longitude r'90.7 $iJ
3. Approximate date land -disturbing activity will commence:
4. Purpose of development (residential, commercial, industrial, Institutional, etc.): j''fSl'Grthiri, 1
S. Total acreage disturbed or uncovered (Including off -site borrow and waste areas): Qt�"Q
6. Amount of fee enclosed: $ *0,04 . The application fee of 400 per acre (rounded up to the next
acre) Is assessed without a ceiling amount (Example: a 10-acre application fee is $4.000).
7. Has an erosion and sediment control plan been filed? Yes ✓ No Enclosed
8. Person to contact should erosion and sediment control Issues arise during land -disturbing acttvlty: f
Name �c�t�, A E-mail Address 4Vm C J.A IAgI @ re"',
W
Telephone $— )2-71 Cell tt 2.7s -SS6 -/ S79 Fax # /V
9, Landownar(s) of Record (attach accompanied page to Ilst additional owners):
-14!t
4-t,^A
"Me IIlk
'925 -52-1-979 dA
Name'
Telephone Fax Number
1-701
/
I
Current
Mailing Address
Current Street Address
:rpkr
rrsr d
NC 2MW
: {y_ OLy!?rti f7 VC R867F
City
State Zip
City State ZIP
10, Deed Book No. 07%71-f Page No. 6542, Provide a copy of the most current deed.
Part B.
1. Company(ies) or flrrn(s) who are financially responsible for the land -disturbing activity (Provide a
comprehensive list of all responsible parties on an atteched sheet.) If the company or firm is a sole proprietorship,
the name of the owner or manager may be Wades the Rnancialiy m sporWble party.
1Wf,er! �n Iv. �grS C,
Name jVrc a f cjrr f E-rrta I Address
GgT0 &-rur't v 71-L
Current Mailing Address Current Street Address
Z Z ("AFH-c 10
City State Zip City State Zip

Telephone Fax Number
2. (a) If the Financially Responsible Party Is not a resident of North Carolina, give name and street address of the
designated North Carolina Agent:
Name
Current Mailing Address
City State ZIP
E-mail Address
Current Street Address
Clty
Telephone Fax Number
state Zip
(b) If the Anancially Responsible Party Is a Partnership or other person engaging In business under an assumed
name, attach a copy of the Certificate of Assumed Name. If the Financially Responsible Party is a
Corporation, give name and street address of the Registered Agent:
cvfk$,A 6Nef - (00"
Name of Registered Agent E-mail Address
qloo (!ZirKiw 1 Z
Current Meiling Addrees Current Street Address
C(,6V1R A/( 2 O
City State ZIP City State ZIP
Telephone % b H - a 614 - `1 S7 Z Fax Number
The above information Is true and correct to the best of my knowledge and belief and was provided by me
under oath (This form must be signed by the Financially Responsible Person If an Individual or his attomey-
In-fact, or if not an Individual, by an officer, director, partner, or registered agent with the authority to
execute Instruments for the Financially Responsible Person). I agree to provide corrected information
should there be any change In the information provided herein.
Lci lorl nweiP i_
Type or dnt name Title or Authority
_U--/O� oaa
ft-aTureo Date
I, I, f AgAt.l LAor a Notary Public of the County of U
State of North Carolina, hereby certify that Tc� me h+a appeared
personalty before me this day and being duly sworn acknowledged that the above form was executed by
him.
Witness my hand and notarial seal, this —AQ_day of :a
AIV L p0''�.,
TA 9
_ � A�' Notary
nA G z; My commleslon expires_Z'u►A e tG , U 2-6
'F [/BLS
�`'��BURG CC ,•�°•

BK 7874 PG 0542
FILED
UNION COUNTY, NC
CRYSTAL D, GILLIARD
REGISTER OF DEEDS
AT FILED Nov 06, 2020
BOOK 12:02 pm
07874
START PAGE 0542
END PAGE 0643
INSTRUMENTIY 45495
EXCISE TAX $420.00
taut
Pnpand by. Love A Hu"A PLLA Richard 1t. Mst4ft. in K JaMrson at, tllonrea, NC Tbl if
Lail tar ORANTEE
prdm Tfs 4444Ma O,p
TFf lal Na 7.1s0�e!!6 ]'a„dlMoa.r Na
iN iced b 0 v (y se ar of .10
Brief Description for the index 46,t Ill, Weddtaglon Aorss, Plat MO.O, Vila
NORTH CAROLINA GENERAL WARRANTY DEED
t . THIS DEED made this 21 day of _OrldTJ Me, by aW between:
GRANTOR ORANTEB
SUNBELT HOLDINGS 881. LLC, Jay 11. Mehl:4 and wife, Rims J. Mohia
a Nevada livaliad Habillty company
lfailingAddrsstt
1701 Painted Hone Drive
lodlsn Trail, NC M79
1 RaaetaapF+PWaNaekMaar►/artp:s�ra.vaddraa•sail.da,rffpnata.clwrwrM.nuy.ag,owperaumerparta.r.Mp.
IThe 44niption Onntm and Ormk* as used heroin shall Include said pani", their hsln, successors, and sualgna,
sad shill Mule tdsgulee, plural. muou"o. feminine or router as mquind by owtaxt.
c WITNF.88M, that tin Orentor, be a vahobla ooaelderotion paid by " Qrantoe, ON "Ipt of which In benby
RAno,sledgw. has and by do" pnrats does Brent, bargain, sell end convey unto the Orantae in its simple, All that
•t ssrtain lot or psivsi of land ~hated ImVettoe Tmmahlp, Union Ceanty, North Carolina and mom particularly
, � dtaeribed � folbws:
i
-j BEING all of Yet 13,Weddington Acres subdivision, as shown on map recorded In flat
Cabinet O, Plies 864969, Union County Registry, reference to which Is hereby made for
a moro particular description.
E (NC dS j 10 411,11) The property belor Boat eyed herein does not contain the prlmsrY rssldenna
of sko orsntor.
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