54064D - Sisson

CAMA / DREDGE & FILL
GENERAL PERMIT Previous permit#
New M�Liification JComplete Reissue ❑Partial Reissue Date previous permit issued
orized by the State of North Carolina,Department of Environment and Natural Resources Coastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC 7--7_
i-i • o ()Lk
[ Rules attached.
nt Name _ , SSC Project Location: County New �1 C 4 C i-'
s ,y e n'' +V . Street Address/State Road/Lot#(s)
.`1rik vilie IS-c�cl> State t ZIP � �tr6Q ((f. ��10YC� �1V'G
# ( ) (, � r1r6 Fax#( ) Subdivisionity
ized Agent l!}Mt1>>/ �o1-�� eti ZIP oL\yti�
City
d CW EW `PTA E ES ❑PTS Phone# ( llt ) 231—kS I Li River Basin C AVe
C OEA HHF IH ❑UBA ❑N/A Adj.Wtr. Body l eNsCl'IQtio,ct
na
❑ PWS: ❑FC: (IC so(inc.(
l.1 no
yes / PNA yes / Crit.Hab. yes / Closest Maj.Wtr. Body qv,eteivi
of Project/Activity i\.e a ° tX i. 1-j -h }�mil cft71( c�yyi bit Lk"k-
J J in
(Scale: I 7:
Jock)length
rm(s) 11111111 I
lengthill 1'j / 11211,1211
1111 �camberWOO i I 111 IHHhI
?ad/Riprap length � . „ �� z a�i7
ivg distance offshore I%SII0IIIIIi:1III1NhI
- li �pC ■�1►' ■ ■�n� i
nax distance offshore i
channel lUllllllliiiii!i
yards i'IlI
cruse/Boatlift VSk 1�i iiiiiOiL1Iai
iii ii'
11 aItHhllu
Bulldozing
�r Il
ine Length
not sure yes F
igs: not sure yes III ■■ _ ,
. '. 1 11111 '1 '® Illial
�num: n/a yes• no ,1i1/�t/��MENIM�EM � IIII� A•Attached: yes no 1 � v ; , 4+1'(i ,
Z.
ling permit may be required I ' mon ti4 WI?), See note on back regarding River Basin 1
ic..ar.:.ir....a:«:...e ktiIf I- u aiici f.si►At,. "ii. ,i ,,-:n., . I., A ,tlam'. , -- It,

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23 09 12: 59p p• 1
'/?ram/, i • G3 ) 2
S
NCDENR
�,...n r"•r {'..a rlert pl;rvireri7cn a":Natural Re5C.Jr;es
Division of Coastal Management a,liarr G.pass J. � ec:,ry
richae+F Easley,G an e:no, Chem S.Jones.Difecto'
Authorized Agent Consent Agreement
;met /`jo�`" L... is here'oy authorized 7c act on my tthg f
rirleo kcroe of Avei}
it order to obtain any CAMA perrnit(s)r tired f•or the prcDerty Iistted below The authorization is lilrlted to he
s ecific activit,es ctrscribed in. the atkached sketch.
L )CATION OF PROJECT:
f ROPERTY OWNER MAULING ADDRESS:
// Sl-tale
Gl/4/6 -(TS e'/ /j45,40-L /i1 G .
a7S-44.60 PHONE NO. 1 l tf
/
UTHORIZCD AGENT MAILING AODRESS:
'c1jc� r v
t 3/4� teN)
tii I r / P .
ft-r ;,J o ,J /\ C. i t4/0 '3
PHONE NO. GI/D -;23l- 2 /4
ignature of Property Owner 2_
r,grlefure of Authorized Agent / i
•

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✓c v Q �1 -) " O c r) h t- 11 S `' 0 11 0 4, I'
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�o �sn9 S )ZA cep O A� s a0N f-j 7 --)(. 0
c.-„ / hv01-i_ av Lo J � �Oc- )3 F kis
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�oi,1 0 s c�/;��y) ✓n ='r✓ S .tea i 4 C. i S ► D S ►
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DCM MP-1.
APPLICATION for ..--":4°
Major Development Permit
(last revised 12/27/06)
North Carolina DIVISION OF COASTAL MANAGEMI
1. Primary Applicant/Landowner Information
Business Name Project Name(if applicable)
•
Applicant 1: First Name MI Last Name
��, t 55a <lr-
Applicant 2: First Name MI Last Name
If additional applicants,please attach an additional page(s) with names listed.
Mailing Address
PO Box City State
ZIP Country Phone No. FAX No.
9 ext.
Street Address (if different from above)
City State ZIP
Email
2. Agent/Contractor Information
Business Name
�l Qi. • t /) n/ C /r
l Ali 5 C ( Hot,-i �� �.x)a-51'fuc { . 0. J
Agent/Contractor 1: First Name,. MI Last Name
k-Do
Agent/Contractor 2: First Name MI Last Name
Mailing Address
PO Box City State
Sn�
3 1.4 L--)( J/-rcis v ; // �/4)c, 4),(4 Ja
ZIP Phone No. 1 Phone No. 2
9(0 - a-3 I - g Sig ext. ex
FAX No. Contractor#
0 Ire _ 1 </_ i Z i) ` _ ,

Form DCM MP-1 (Page 2 of 4) APPLICATION
Major Development Pert
3. Project Location
County(can be multiple) Street Address State Rd.#
/ J('cJ Na/`� ^De)k...) /6, 3 LLD
Subdivision //a Name City �/
i�i State Zip
O/LC)ctr �s / 0./ GJr�stt—ds l�z' 40 c C ,z 8c�
Phone No. Lot No.(s) (if many, attach additional page with list)
9/0 - 5C - / 3 �rJ`� ext. ,
a. In which NC river basin is the project located? b. Namee of body of water nearest to proposed project
foe {—e cKr f. nA.D is s G a to /, /40 C
c. Is the water body identified in(b)above,natural or manmade? d. Name the closest major water body to the proposed project s
Natural EManmade ❑Unknown 44/C1 .PJ;c_ 0C- cy d Li%�L
e. Is proposed work within city limits or planning jurisdiction? f. If applicable,list the planning jurisdiction or city limit the props
work falls within.Yes ❑No L.)1,(30 S Oi /(e t Peac`_
4. Site Description
a. Total length of shoreline on the tract(ft.) b. Size of entire tract(sq.ft.)
1.55l / 3,y 0 /—
c. Size of individual lot(s) d. Approximate elevation of tract above NHW (normal high wet
NWL(normal water level) ,5—
I �zj, CtCf�
(If many lot sizes. please attach additional page with a list) jv]1GHW or❑NWL
e. Vegetation on tract
/0N45C4117�
f. Man-made features and uses now on tract
G1Ock 5e
g. Identify and describe the existing land uses adjacent to the proposed project site.
r e s t Cie"-JI r C: / G'LO r e S
h. How does local government zone the tract? i. Is the proposed project consistent with the applicable zoning?
/
(Attach zoning compliance certificate, if applicable).
e n��tC<
( c 5 1 �*es ONo ❑NA
j. Is the proposed activity part of an urban waterfront redevelopment proposal? ❑Yes Jlo
k. Has a professional archaeological assessment been done for the tract? If yes,attach a copy. ❑Yes 'IgNo gNA

Form DCM MP-1 (Page 3 of 4) APPLICATION
Major Development Pe
m. (i) Are there wetlands on the site? Q�Yes No
(ii)Are there coastal wetlands on the site? l ,('es ❑No
(iii)If yes to either(i)or(ii)above,has a delineation been conducted? ❑Yes , No
(Attach documentation,if available)
n. Describe existing wastewater treatment facilities.
e� Yc
o. Describe existing drinkinawater supply source.
p. Describe existing storm water management or treatment systems.
sue,^-cac e .�tvo4f
5. Activities and Impacts
a. Will the project be for commercial,public,or private use?/ �/ ❑Commercial ❑PubliciGovernment
i3 e a`7e/re°sct de,S t a/ ❑Private/Community
b. Give a brief description of purpose,use,and daily operations of a project when complete.
Reiv't de a cJee1'2 S (.�\ Co.r eq.e -j 0c.S r A ! / Fy
3 1,.04 (.NS N
emu/ S l�tare . 1 a CxoC � (ooG.Us alan�5 s• de .2> F-laG� lam .
cpo� c ,
c. Describe the proposed construction methodology,types of construction equipment to be used during construction,t� the number of eac
of equipment and where it is to be stored. ; (; S %S � Cl (a a SCFo i e r o t
iCr3S r; S (lo S� p l S
d. List all development activities you propose.
; c E/ �/r
s(� 14 `1/4S �
Prop 0s 0 5 , �
LJ�st/ pt.°,; wer der`f1�
"C o I. i�a a 4
e. Are the proposed activities maintenar:e pf an existing pro[ect,new work,or betrr?
p14,. c 6 f"ee.OP rsute e,�,a ""S s /rccL�ceie
•
f. What is the approximate total disturbed land area resulting from the proposed project? Q ❑Sq.Ft or❑Aci
g. Will the proposed project encroach on any public easement,public accessway or other area Oyes `fikio DNA
that the public has established use of?
h. Describe location and type of existing and proposed discharges to waters of the state.
Surface :t,ivoT`c-
. 11/8I l......,.,�,e.tie.lie,-F,•mrnuri into wntiknrl9 nYes DNA

Form DCM MP-1 (Page 4 of 4) APPLICATION
Major Development Pe
6. Additional Information
In addition to this completed application form,(MP-1)the following items below,if applicable,must be submitted in order for the appiicatio
package to be complete. Items(a)—(f)are always applicable to any major development application. Please consult the application
instruction booklet on how to properly prepare the required items below.
a. A project narrative.
b. An accurate,dated work plat(including plan view and cross-sectional drawings)drawn to scale. Please give the present status of the
proposed project. Is any portion already complete? If previously authorized work,clearly indicate on maps.plats,drawings to distingu
between work completed and proposed.
c. A site or location map that is sufficiently detailed to guide agency personnel unfamiliar with the area to the site.
d. A copy of the deed(with state application only)or other instrument under which the applicant claims title to the affected properties.
e. The appropriate application fee. Check or money order made payable to DENR.
f. A list of the names and complete addresses of the adjacent waterfront(riparian)landowners and signed return receipts as proof that st
owners have received a copy of the application and plats by certified mail. Such landowners must be advised that they have 30 days i
which to submit comments on the proposed project to the Division of Coastal Management.
Name /4Nra tC G. La e- �rtt Phone No.
Address 1,� !h ( �rc..171,0;l"P i:��% /- c . �.?t(7? !i 61/0- .66
Name �j0(4,, la," 4-7o,Jr s Phone No.
Address jL 5( re lll. L), g
< t
Sl4lfso;/l& SeI- !L C� �1 . C�'/O - <�,
Name Phone No.
Address
g. A list of previous state or federal permits issued for work on the project tract. include permit numbers. permittee,and issuing dates.
h. Signed consultant or agent authorization form,if applicable.
i. Wetland delineation,if necessary.
j. A signed AEC hazard notice for projects in oceanfront and inlet areas. (Must be signed by property owner)
k. A statement of compliance with the N.C.Environmental Policy Act(N.C.G.S. 113A 1-10),if necessary. If the project involves expend
of public funds or use of public lands.attach a statement documenting compliance with the North Carolina Environmental Policy Act.
7. Certification and Permission to Enter on Land
I understand that any permit issued in response to this application will allow only the development described in the applic
The project will be subject to the conditions and restrictions contained in the permit.
I certify that I am authorized to grant, and do in fact grant permission to representatives of state and federal review agent
enter on the aforementioned lands in connection with evaluating information related to this permit application and folt
monitoring of the project.
I further certify that the information provided in this application is truthful to the best off y
knowledge.Date 6/l4 ©S' Print Name i0--t/-c47 /`70^(1-6SPh' 1
���lit/�/Signature �--)

Form DCM MP-4
STRUCTURES
(Construction within Public Trust Areas)
Attach this form to Joint Application for CAMA Major Permit, Form DCM MP-1. Be sure to complete all other sections of the
Application that relate to this proposed project. Please include all supplemental information.
1. DOCKING FACILITY/MARINA CHARACTERISTICS ❑This section not
a. (i) Is the docking facility/manna: b. (i)Will the facility be open to the general public?
['Commercial ❑Public/Government rivate/Community ❑Yes ,10
c. (i)Dock(s)and/or piers) d. (i)Are Finger Piers included? ❑Yeslo
(ii)Number ^/ / If yes: LL,r�
(iii)Length // /4/� �r/� 1•.". \ (ii)Number iJ7�7
•
(iv)Width >`/7 ( / " ; ' ) (iii)Length /104
(v)Floating Yes ❑No (iv)Width W151
(v)Floating Oyes ❑No
e. (i) Are Platforms included? ❑Yes ❑No f. (i) Are Boatlifts included? Oes ❑No
If yes: If yes:
(ii)Number j (ii)Number
n i I
(iii)Length / D (iii)Length I
r
(iv)Width / ' (iv)Width /3
(v)Floating ❑Yes j No
Note: Roofed areas are calculated from dripline dimensions.
g. (i)Number of slips proposed h. Check all the types of services to be provided.
❑ Full service. including travel lift and/or rail.repair or
maintenance service
(ii)Number of slips existing
❑ Dockage, fuel,and manne supplies
❑ Dockage("wet slips")only.number of slips:
❑ Dry storage:number of boats:
❑ Boat ramp(s): number of boat ramps:
B Other,please describe: /'
i boc., 3Octca.s
i. Check the proposed type of siting j. Describe the typical boats to be served(e.g.,open runab
❑ Land cut and access channel charter boats,sail boats,mixed types).
❑O n water:dredging for basin and/or channel C 7 c,u f
Z pen water:no dredging required
['Other: please describe:

2. DOCKING FACILITY/MARINA OPERATIONS Sgthis section not
a. Check each of the following sanitary facilities that will be included in the proposed project.
❑Office Toilets
❑Toilets for patrons; Number: ; Location:
❑ Showers
❑ Boatholding tank pumpout;Give type and location:
b. Describe treatment type and disposal location for all sanitary wastewater.
c. Describe the disposal of solid waste,fish offal and trash.
d. How will overboard discharge of sewage from boats be controlled?
e. (i)Give the location and number of"No Sewage Discharge"signs proposed.
(ii)Give the location and number of"Pumpout Available"signs proposed.
f. Describe the special design.if applicable, for containing industrial type pollutants, such as paint, sandblasting waste and petroleum p
g. Where will residue from vessel maintenance be disposed of?
•
h. Give the number of channel markers and"No Wake-signs proposed.
i. Give the location of fuel-handling facilities, and describe the safety measures planned to protect area water quality.
j. What will be the marina policy on overnight and live-aboard dockage?
•k. Describe design measures that promote boat basin flushing?

m. Is the marina/docking facility proposed within a primary or secondary nursery area?
OYes ONo
n. Is the marina/docking facility proposed within or adjacent to any shellfish harvesting area?
❑Yes ONo
o. Is the marina/docking facility proposed within or adjacent to coastal wetlands/marsh(CW),submerged aquatic vegetation(SAV),shel
(SB),or other wetlands(WL)? If any boxes are checked,provide the number of square feet affected.
❑CW OSAV OSB
•
OWL ❑None
p. Is the proposed marina/docking facility located within or within close proximity to any shellfish leases? :Yes [No
If yes,give the name and address of the leaseholder(s), and give the proximity to the lease.
3. BOATHOUSE(including covered lifts) This section no
a. (i) Is the boathouse structure(s):
❑Commercial ❑Public/Government ❑Private/Community
(ii)Number
(iii)Length
(iv)Width
Note: Roofed areas are calculated from dripline dimensions.
4. GROIN (e.g., wood, sheetpile, etc. If a rock groin, use MP-2, Excavation and Fill.) ,This section no
a. (i) Number
(ii)Length
(iii)Width
5. BREAKWATER (e.g., wood, sheetpile, etc.) his section nc
a. Length b. Average distance from NHW.NWL.or wetlands
c. Maximum distance beyond NHW.NWL or wetlands
6. MOORING PILINGS and BUOYS section nc
a. Is the structure(s): b. Number
['Commercial ❑Public/Government OPrivate/Community
c. Distance to be placed beyond shoreline d. Description of buoy(color,inscription,size, anchor,etc
Note: This should be measured from marsh edge, if present.

GENERAL
. Proximity of structure(s)to adjacent riparian property lines b. Proximity of structure(s)to adjacent docking facilities.
> 30 /O�
Note: For buoy or mooring piling, use arc of swing including length
of vessel.
. Width of water body d. Water depth at waterward end of structure at NLW or NWL
>11Cr
jL(L c.J
. (i) Will navigational aids be required as a result of the project?
❑Yes ONO DNA
(ii)If yes,explain what type and how they will be implemented.
OTHER _ rhis section not ap)
. Give complete description:
/O, QUr �IfS�PLc:A� Je 0G 5 Irrc->3) 4n�Gl
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ate
roject Name
pplicant Name
v/L-S`?'"/
pplican ignat re •

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1 19 09 03: 55p
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Nor.
REBECCA P. SMITH
REGISTER OF DEEDS, NEW HANOVER
216 PIORTH SECOND STREET
WI LMI NGTON, NC 28401
AIM ' . A.A.4..i.»fiilil•Mwti*iisl►Wri4 *b** ** tiiiiifiif►M'fitYrMKMA#NM MMwMMY
FIIed For Registration: 10/1012A06 10:07:39 AM
Book: RE 5090 Page: 26-30
Document No.: 2006056809
DEED 5 PGS $23.00
Recorder; STORER, MARVIS ANN
State of North Carolina,County of New Hanover
YELLOW PROBATE SHEET IS A VITAL PART OF YOUR RECORDED DOCUMENT,
PLEASE RETAIN WITH ORIGINAL DOCUMENT AND SUBMIT FOR RE-RECORDING.

19 09 03: 54p p. 5
EXHIBIT"A"
First Tract:Being all of lot number 36 of Shore Acres Development number one as surveyed and
platted by J. L. Becton, Civil Engineer, and as recorded in the office of the Register of Deeds for
New Hanover County in Map Book#3 at Page 65.
Second Tract: Being a part of Lot#37 of Shore Acres company Development#1 as surveyed and
platted by J. L. Becton,Civil Engineer, and as recorded in the office of the Register of Deeds far
New Hanover County in Map Book# 3 at Page 65 and being more particularly described as
follows,to wit; Beginning at a point in the Southern line of Myrtle Street 6 feet Eastwardly from
the point of intersection of the Wes.ern line of Lagoon Place with the Southern line of Myrtle
Street and running thence Eastwardly with the Southern line of Myrtle Street 19 feet to the
Northwest corner of Lot#36 of said Shore Acres Company Development#1; thence southwardly
along the dividing line ''netween lots 36 and 37 eighty-seven and eight tenths(87.8) feet;thence
Westwardly along the Southern line of Lot#37, 87 feet more or Iess;thence deflecting slightly to
the right 12 feet on line shown as 15 feet on said map; thence Eastwardly across Lot#37 in a
straight line 110 feet,more or less to the point of Beginning.
Together with hail riparian rights as set out and described in deed from Shore Acres Company to
Roger Moore dated Oct. 3 A.D. 1939 and recorded in Book 290 Page 243 of New Hanover
County Registry.

p. 4
1 19 09 03: 53p
SHORE DRIVE HOLDINGS,LLC
(SEAL)
WILLIAM E. SISSON,JR.,Me anager
STATE OF NORTH CAROLINA
COUNTY�^ OF NEW HANOVER
I, G tcl C„yzj ij }1 .,uS a Notary Public, certify that the foylowing person(s)personally
appeared before me this day,and
0 I have personal knowledge of the identity of the principal(s)
Iti' I have seen satisfactory evidence of the principal's identity,by a current state or
federal identification with the principal's photograph i the form of a .14C'DI..
: ,if \Ea,
O A credible witness has sworn to the identity of the principal(s);
each acknowledging to me that he or she voluntarily signed the foregoing document for the
purpose stated therein and in the capacity indicated:
Name
Capacity,
'William E. Sisson, Jr. �iember/Manager
On behalf of and as the act of the following entity: Shore Drive Holdings, LLC
•
Date: D--G--OLO
t�� � Notary Public
i t Zr�fx-W► i I I QF4 LS (print name)
(official seal) My commission expires: fQ.b 2-0 lI
r
Elizabeth Williams
Notary Public
New Hanover Co., NC
My Commission Expires 2/28/2011

i p. 4
19 09 03: 53p
SHORE DRIVE HOLDINGS,LLC
By;/
(SEAL)
WILLIAM E. SISSON,JR.,Me anager
STATE OF NORTH CAROLINA
COUNTY OF NEW HANOVER
I, ar, i. ;,It;cLi a Notary Public, certify that the following person(s)personally
appeared before me this day,and
0 I have personal knowledge of the identity of the principal(s)
I have seer satisfactory evidence of the principal's identity,by a current state or
federal identification with the principal's photograph i the form of a( )f�lCDl.Carol;v►a.) »,e�-z .c�►� ,
❑ A credible witness has sworn to the identity of the principal(s);
each acknowledging to me that he or she voluntarily signed the foregoing document for the
purpose states therein and in the capacity indicated:
N rune Ca_city
�V+'illiam E. Sisson, Jr. Member,'Manager
On behalf of and as the act of the following entity; Shore Drive Holdings, LLC
Date: ����—QLp 1 ' r otary Public
F1rzn ix-Wt tAJ1 l! ;rites _(print name)
(official seal) My commission expires: fQ.b `5r;-Q!J
Elizabeth Williams
Notary Public
New Hanover Co., NC
My Commission Expires 2/28/2011

19 09 03: 52p P• 2
101111111111111111
FOR REGISTRATION RESISTER OF CEEDS
RESECCR P. SRITM
NEVI MRNOVEA cOtiITY NC
2036OC' 1Q 10:01: 9RM
BK:5090 PG:26-30 FEE S23.00
NIMBIfB0605 G
drRevenue Stamps: $0,00 This conveyance has been made Recording time, book and page
strictly for buane7s purpose:, no con3ideratwn has been
asked or given
Parcel Identifier No.R06307-016-004-000
No certification or opinion on title is expressed by the preparer of this deed except as may appear from the preparer's
signed certificate or opinion.
Prepared by: W.Talmage Jones
Hogue,Hill,Jones,Nash&Lynch,L.L.P.
P.O.Drawer 2178
Wilmington,NC 28402
Grantee mailing address.4766 Oleander Drive,Wtirnington NC 28403
Returned to:KHJNL
STATE OF NORTH CAROLINA
DEED IN DISSOLUTION
COUNTY OF NEW HANOVER
KNOW ALL MEN BY THESE PRESENTS:hat SHORE DRIVE HOLDINGS,LLC,a
North Carolina limited liability company(dissolved), conveying its assets to its sole member,
pursuant to NCGS 57-C-6-05, "GRANTOR;"in consideration of TEN AND NO/[00(S10.00)
DOLLARS and other good and valuable consideration,paid to GRANTOR by WILLIAM E.
SISSON,JR. and wife, MARILYN JOY MILLER, "GRANTEE," the receipt of which is
hereby acknowledged,by these presents. does give,grant, bargain,sell and convey unto the said
GRANTEE. and GRANTEE'S heirs,successors,and assigns, forever,in fee simple,all that
certair.lot or parcel of land Iocated in the Town of Wrightsville Beach. County of New Hanover,

i 19 09 03: 53p p• 3
See attached Exhibit A, incorporated herein as if set out in full.
This is the very same property conveyed to Grantor by deed recorded November 6,2001
in Book 3098, Pages 175-184 of the New Hanover County Registry.
TO HAVE AND TO HOLD the aforesaid lot or parcel of land and all privileges and
appurtenances thereto belonging, to the said GRANTEE and said GRANTEE's heirs, successors,
and assigns,forever, in fee simple: and the GRANTOR, for itself, its successors and assigns,
does covenant with the said GRANTEE and said GRANTEE's heirs, successors and assigns,that
GRANTOR is seised of the premises in fee simple,and has the right to convey the same in the
estate aforesaid,that title is marketable and free and clear of all encumbrances,except as herein
stated. and that GRANTOR hereby will warrant and defend the title against the lawful claims of
all persons whomsoever,except for the exceptions herein stated.
Title to the property is subject to the following exceptions:
The provisions of all applicable zoning and land use ordinances, statutes and regulations;
current year ad valorem taxes; and
all applicable restrictive covenants and utility easements of re:ord.
The designation GRANTOR and GRANTEE as used herein shall include said parties,
their heirs, successors, and assigns,and shall include singular,plural, mascu iine, feminine or
neuter as required by context.
IN WITNESS WHEREOF,the GRANTOR has hereunto set his hand and seal,or if
corporate,has caused this instrument to be signed in its corporate name by its duly authorized
0-th
officer,this the'!day of (" ,: ) ,2006.

•
- 1 COASTAL MARINE DOCKS & BULKHEADS
NCDL 3831595
e 6314 WRIGHTSVILLE AVE 910-256-6357
WILMINGTON,NC 28403
DATE / )
TPAY
O THE .b ✓//
ORDER OF 11��///._�N ( i
�[ -G� � aZ_ ��--'J DOLLARS
1111 WACHOVIA
Wachovia Bank,N.A. cif f 9��C, I D
Ywachovia.com �
a FOR ('. /(..5f n
11'0 l 6 5 3 9111 1:0 5 3000 2 l 91: 208 6 l 70 8 1II.

SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
• Complete items 1,2,and 3.Also complete A. Si re
item 4 if Restricted Delivery is desired. X • S 0 Agent
• Print your name and address on the reverse ; ! 0 Addressee
so that we can return the card to you. B. Recpiv b (Prin=• - e) C. Date of Delivery
• Attach this card to the back of the mailpiece, r
or on the front if space permits. LJ�h '^ ✓ ,, e 7 GJ-U
D. Is delivery ad¢ rfferent frofk 17 0 Yes
1. Article Addressed to: If YES,enter veryaddress be ❑ No
/q/GI.J C,'`' 6-'S I '& 45
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N /4 fJCL N 3. Service Type -_--_-)
0 Certified Mail ❑ Express Mail
c( D ❑Registered 0 Return Receipt for Merchandise
0 Insured Mail ❑C.O.D.
4. Restricted Delivery?(Extra Fee) ❑YeS
2. Article Number
(Transfer from service label) 7009 0080 0001 3653 6868
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540
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REC'D J U N 2 6 2009
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SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
• Complete items 1,2,and 3.Also complete A. Signature
item 4 if Restricted Delivery is desired. �1�t.A 0 Agent
■ Print your name and address on the reverse �r „�- ❑Addressee
so that we can return the card to you. B. Received by(Print Name) C. Date o Delivery
• Attach this card to the back of the mailpiece, cI
or on the front if space permits. g t LAN A_ I C O
D. Is deliv= -srrpfss• .-rent from item 1? ❑Ye