NCC230883_FRO Submitted (3)_20230330

Company DBA Name
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(s)
or his attorney -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 Party). I agree to provide
corrected information should there be any change in the information provided herein.
Miodrag Todorovic
Type or print name
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Signature
owner
Title or Authority
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Date
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I,2c, 0, y-, <'\Z— , a Notary Public of the County of
State of North Carolina, hereby certify that1 Li ��C kQ) Ut c, appeared personally
before me this day and being duly sworn acknowledged th#t he above form was executed by him/her.
Witness my hand and notarial seal, this day of 1 1C�� , 202
My commission expires
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