SC_11-25_ Harvey

Issued by WiRO SC 11-25
Surf City Permit Number
CAMA
MINOR DEVELOPMENT
PERMIT
as authorized by the State of North Carolina,Department of Environment,
and Natural Resources and the Coastal Resources Commission for development
in an area of environment concern pursuant to Section 113A-118 of the
General Statutes,"Coastal Area Management"
Issued to Clark and Carole Harvey, authorizing development in the Estuarine Shoreline (AEC) at 106 Abigail Court, in
Surf City, Pender County as requested in the permittee's application, dated December 23, 2011, and received by DCM
on December 28, 2011. This permit, issued on January 23, 2012, is subject to compliance with the application and site
drawing (where consistent with the permit), all applicable regulations and special conditions and notes set forth below.
Any violation of these terms may subject permittee to a fine, imprisonment or civil action, or may cause the permit to be
null and void.
This permit authorizes: the construction of a single family residence on Lot 16 in the Cedar Point Subdivision.
(1) All proposed development and associated construction must be done in accordance with the permitted work plat
drawings(s)dated received on December 28, 2011.
(2) All construction must conform to the N.C. Building Code requirements and all other local, State and Federal regulations,
applicable local ordinances and FEMA Flood Regulations.
(3) Any change or changes in the plans for development, construction, or land use activities will require a re-evaluation and
modification of this permit.
(4) A copy of this permit shall be posted or available on site. Contact this office at [phone] for a final inspection at
completion of work.
(Additional Permit Conditions on Page 2)
This permit action may be appealed by the permittee or other qualified persons
within twenty (20) days of the issuing date. From the date of an appeal, any ce)
work conducted under this permit must cease until the appeal is resolved. This
permit must be on the project site and accessible to the permit officer when the
project is inspected for compliance. Any maintenance work or project Jason Dail
modification not covered under this permit, require further written permit CAMA LOCAL PERMIT OFFICIAL
approval.All work must cease when this permit expires on:
127 Cardinal Drive Extension
December31,2015 Wilmington, NC 28405- 845
In issuing this permit it is agreed that this project is consistent with the local Land
Use Plan and all applicable ordinances. This permit may not be transferred to
another party without the written approval of the Division of Coastal PERMITTEE
Management. (Signature required if conditions above apply to permit)

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Name: Clark and Carole Harvey
Minor Permit#SC11-25
Date: January 23, 2012
Page 2
(5) Unless specifically allowed in 15A NCAC 07H. 0209(d)(10), and shown on the permitted plan drawing, all
development/construction shall be located a distance of 30 feet landward of Normal High Water level. Any portion of
the permitted "cantilevered deck" extending into the 30 foot Coastal Shoreline buffer shall be uncovered and less
than 200 square feet in size.
(6) All unconsolidated material resulting from associated grading and landscaping shall be retained on site by effective
sedimentation and erosion control measures. Prior to any land-disturbing activities, a barrier line of filter cloth must
be installed between the land disturbing activity and the adjacent marsh or water areas, until such time as the area
has been properly stabilized with a vegetative cover.
(7) Any proposed for grading within the 30' buffer from the Normal High Water level must be contoured to prevent
additional stormwater runoff to the adjacent waterbody. This area shall be immediately vegetatively stabilized, and
must remain in a vegetated state.
(8) The applicant has effectively demonstrated, through innovative construction design, that the amount of impervious
surface areas may be exceeded in a way that runoff water will be managed and the AEC protected, so as to allow
1,682 square feet of impervious areas within the 75' Coastal Shoreline AEC. All proposed development and
associated construction must be done in accordance with the design specifications of the permitted innovative
design, sealed by the design professional, David Newson, on map dated December 22, 2011.
(9) Upon completion of construction and prior to the issuance of a Certificate of Occupancy(CO), a letter of certification
must be received from the designer of the innovative system installed, certifying that the permitted system has been
installed in accordance with this permit, the approved plans and his design specifications. Any deviations from the
approved plans and specifications must be noted on the Certification and a permit modification may be required
prior to receiving a CO.
(10) The landowner or permittee shall at all times provide the operation and maintenance necessary to assure the
permitted stormwater system functions at optimum efficiency. The landowner or permittee shall maintain the
permitted stormwater system for the life of the project.
SIGNATURE: DATE: / ^'2‘- (7—
PERMITTEE

•Penn i(liliirti•ueY. :. ��'.:. ,• • .
• •
Qrr`gti;Haril :: :Esktiar�lte 'hovel ' c: ''
. ., ..�:' . �. tt? . Oli,.1'�';Slit/"re)ine; •':PulSlic•Titist Shoreliide •�,_•• thtrr'•-�•
(;FNl�I.tAL INFORT ATlON
LAND OWNER •
Nan,c_C 1 A/21( L ,9�c/�f1 'C/9R o 4. .•w. 17R 0e ..
Address . /PN [. r Le"( N
•
City ,i< 4.'/4 j2 State P /9 Zip/1/4.0,Phone ZL4' - ,
1:maii hi"40 2 s ►4 w c T it.JA
AUTHORIZED AGENT
Name )1 ,c,r /1�/. --`—
Address P ea 2 2 7 0 41
City u e � , 1•'r.__�. Slate C _ Zip 2i`/` Phone (9/D) 3g 1- 70 .7 7
Email •
LOCATION OF PROJECT: (Address,street name and/or directions to site.if not oceanfront, wh<ot is the name of the •
adjacent waterbody.)/d(d40�, cT 1$c.t�C.i'>,4'C.-2 ew5e.0 L.4°' ' Ca r>�, ? r PI J IDt Gr,..y.
*C_ r �.vtc c.oet sr;•! BA rre_r G iV�►.�.� .
DESCRIPTION OF PROJECT:(List all proposed construction and land disturbance.)REiaw,°"4'< L4:i,rvre
A e, .s.e.- ~ Riivr /V s r'. if,p J•'-f-s, r/frry j P e L..�,_.,�� a, ,i ...� r�or f!o u c qZ
SIZE OF LOT/PARCEL: 9,7_d 5 /S square feet . 2... acres
PROPOSED USE: Residential ix (Single-family , Multi-family fl ) Commercial/Industrial fl Other El
COMPLETE EITHER(1)OR(2)BELOW(Contact your Local Permit Officer if you are not sure which AEC applies
to your property):
(1) OCEAN HAZARD AECs:TOTAL FLOOR AREA OF PROPOSED STRUCTURE: - square feet(includes
air conditioned living space,parking elevated above ground level,non-conditioned space elevated al-mve ground level but
excluding non-load-bearing attic space)
(2) COASTAL SHORELINE AECs: SIZE OF BUILDING FOOTPRINT AND OTHER IMPERVIOUS OR BUILT
UPON SURFACES:1377.1quare feet(includes the area of the roof/drip line of all buildings,driveways,covered decks,
concrete or masonry c)atios,etc.that are within the applicable AEC.Attach your calculations with the project drawing.) •
STATE STORMWATER MANAGEMENT PERMIT: is the project located in an area subject to a State Stormwater
Management Permit issued by the NC Division of Water Quality?
YES t/ NO
If yes,list the total built upon area/impervious surface allowed for your lot or parcel: If C�_o tiv E D
DEC 2 8 2011
')CM WILMINGTON, NC

•
OTHER PERMITS MAY BE REQUIRED:The activity you are planning may require permits other than the CAMA
minor development permit,including,but not limited to:Drinking Water Well,Septic Tank(or other sanitary waste
treatment system),Building,Electrical,Plumbing,Heating and Air Conditioning,Insulation and Energy Conservation, FIA
Certification,Sand Dune,Sediment Control,Subdivision Approval,Mobile Home Park Approval, Highway Connection,and
others.Check with your Local Permit Officer for more information.
STATEMENT OF OWNERSHIiP:
1,the undersigned,an applicant for a CAMA minor development permit,being either the owner of property in an AEC or a
person authorized to act as an agent for purposes of applying for ii CAMA minor development permit.certify that the person
listed as landowner on this application has a significant interest in the real property described therein.This interest can be
described as! (check one)
!X an owner or record title, Title is vested incJ,,RA A. teoP C witA c-11/01t orp see Deed Book .3 97S ,. .
page03) j in the P ,a f,.t County Registry of Deeds.
an owner by virtue of inheritance.Applicant is an heir to the estate of _.—_._.__--__. ,.. - __;
probate was in County.
if other interest,such as written contract or lease,explain below or use a separate sheet&.attach to this application.
NOTIFICATION OF ADJACENT PROPERTY OWNERS:
I furthermore certify that the following persons are owners of properties adjoining this property. i affirm that I have given
ACTUAL NOTICE to each of them concerning my intent to develop this property and to apply for a CAMA permit.
(Name) (Address)
(1) 2 fl e-Nr)/ '9/sid . ,A6A._ ? rG.r 7eP Av..5i5 ry7u&.pp. 6 0,c_A Lid PC,V123°b
(2) - 6 C �JG/ 2 P P /-.7 F S' ..,s4,4e.}- C. i 54tALC,___ .r`/LL5/Sr
(3) .. . .
ACKNOWLEDGEMENTS:
1,the undersigned,acknowledge that the land owner is aware that the proposed development is planned for an area which
may be susceptible to erosion and/or flooding. I acknowledge that the Local Permit Officer has explained to nne the particu-
lar hazard problems associated with this lot.This explanation was accompanied by recommendations concerning stabiliza-
tion and floodproofnng techniques.
I furthermore certify that I am authorized to grant,and do in fact grant,permission to Division of Coastal Management staff,
the Local Permit Officer and their agents to enter on the aforementioned lands in connection with evaluating information
related to this permit application.
This the .Z3/�✓J day of, -A(/r('_, 20 /7
/..e. :2;02!f?.::- _
Landoo.%net or person authorized to act as his/her agent for purpose of filing a CAMA permit application
This application includes:general inJorrnation(this'Orin), a site drawing as described on the hack.of this application, the
ownership statement, the Ocean Hazard AEC Notice where itecesscirl; a cheek for S10(400 made payable to the locality: and
any information as late)-he provided orally by the applicant. The details of the application as described ht'these.sources are
incorporated without reference in any permit which may be issued. Deviation.fivii these details will canstiture a vi 1a • n of
arty permit.Any person developing in an AEC without permit is subject to civil,criminal and adiRr bt ri t.
DEC 2 8 2011
nChf WILMINGTON, NC

A„..,•
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue Braxton C. Davis Dee Freeman
Director Secretary
January 24, 2012
Kent Albertson
PO Box 2704
Surf City, NC 28445
Dear Mr. Albertson:
Attached is CAMA Minor Development Permit# SC 11-25, for work to be done for Clark Harvey at
106 Abigail Ct., in Surf City, Pender County.
In order to validate this permit, please sign both copies of the permit as indicated for our records.
Please retain the gold copy for your files and sign front and back pages of the white copy then return to us
within 20 days of receipt, in the enclosed, self-addressed envelope.
This is not a valid permit until it is signed and returned to our office.
Thank you for your prompt attention to this matter.
Sincerely,Shaun K. Simpson
Permit Support Technician
Enclosures
cc: WiRO files
127 Cardinal Drive Ext.,Wilmington,NC 28405 One
Phone:[phone] FAX:[phone] Internet:www.nccoastalmanagement.net North Carolliina
An Equal Opportunity\Affirmative Action Employer Naturally"aally

A41.0A /14j (1/ c s
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue Braxton C. Davis Dee Freeman
Governor Director Secretary
January 3, 2012
[e-mail]
2 Pages
Star News
Legal Advertisement Section
Post Office Box 840
Wilmington,North Carolina 28402
Re: Harvey/Salmon Combo Minor Public Notice
Kyle: Please publish the attached Notice in the Friday, January 6, 2012 issue.
The State Office of Budget and Management requires an original Affidavit of Publication prior to
payment for newspaper advertising. Please send the original affidavit of the published notice to Melissa
Sabastian, 400 Commerce Avenue, Morehead City, N.C. 28557 [phone].
Please send the original invoice and a copy of the affidavit for payment to Shaun Simpson at Division of
Coastal Management, 127 Cardinal Drive Extension, Wilmington,NC 28405, 910-796-7226.
Paying by Credit Card (number on file with Elsa Lawrence, Ref acct # 796-7215). Please send a fax of the
credit card receipt to me.
Thank you for your assistance in this matter. If you should have any questions, please contact me at our
Wilmington office.
Sincerely,
Shaun Simpson
Permit Support Techm i
Enclosure
cc: File Copy
Michele Walker DCM
127 Cardinal Drive Ext.,Wilmington, NC 28405 One
Phone:[phone]\FAX:[phone] Internet:www.nccoastalmanagement.net North t.Car
Mina
An Equal Opportunity\Affirmative Action Employer Naturally u"aally

CAMA MINOR PERMIT NOTICE
Pursuant to NCGS 113A-119(b), the North Carolina Division of Coastal Management, an
agency authorized to issue CAMA permits in areas of environmental concern, hereby gives NOTICE
that on December 28, 2011 the following applicants'applied for a CAMA permit to construct a single-
family dwelling adjacent to a canal off Topsail Sound, in Surf City, Pender County: Clark Carole
Harvey at 106 Abigail Ct., and Zachary & Susan Salmon at 108 Abigail Ct. The applicati oS lay be
inspected at the address below. Public comments received by January 21, 2012 will be considered.
Later comments will be accepted and considered up to the time of permit decision. Project
modifications may occur based on further review and comments. Notice of the permit decision in this
matter will be provided upon written request.
Jason Dail
Field Representative
Division of Coastal Management
127 Cardinal Drive Extension
Wilmington, NC 28405-3845
Phone: [phone]

NOTICF
CAMA PERMIT
APPLIED FOR
PROJECT:
• . . . $ • Sall • al al - -
family dwelling at 106 Abigail Court, adjacent to a
el W
my
COMMENTS ACCEPTED THROUGH January 1;2012
APPLICANT: FOR MORE DETAILS CONTACT
THE LOCAL PERMIT OFFICER BELOW:
Kent Albertson for C Harvey NC D_„. of Coa tal Management
PO Box 2704 127 Cardinal Dr. Ext.
Surf City, NC 28445 Wilmington, NC 28405
Jason Dail 910 796 7221

4
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Receipts for
Codified Mail
(Staple Here)
ate
Adjacent Prop6rty Owner
-2- 70 0 /577 _5 S 417u,g, v•e-
Mailing Address
G Cad c./YL
City, State, Zip Code
Dear Adjacent Property:
This letter is to inform you that I, C/,i •YG(Rd1-/1/4/ 1{/ have.applied Fora CAMA Minor
Property Owner
Permit on my property at/D _,S fyi/G j.Ser4 C% ,A/C. in COUNTY
/ Property Address
County, As required by CAMA regulations, I have enclosed a copy of my permit application and project
drawing(s)as notification of my proposed project.No action is required from you or you may sign and return
the enclosed no objection form. If you have any questions or comments about my proposed project,please
contact ro at 7,Z.=„3. ��5 ,or bymail at the address listed below. If you wish to •
Applicant's Telephone
file written comments or objections with the LOCAL GOVERNMENT CAMA Minor Permit Program,you may submit
them to:
lQ c.T/N o c- P r,Qir9/T D R S R- C.• r-
/ Z 7 C. DR i L'z5-
Sincerely, Lc a /r7/A/6 re.r '//V G
rek. .9ifD C 1'✓/r'Rvcy
Property Owner /
40?,
Mailing Address
r�xaw /? P�f9 /� S-
City,State,Zip Code
PF:CEIVED
DEC 2 8 2011
11CM WtLnntNGTON, NC

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
FOR CAMA MINOR PERMITS
I hereby certify that t own property adjacent to -4/ i`-"Y 's
,� (Name of Property Owner)
property located at `06 /'t??/ ft✓l
Address,Lot,Block,Road,etc.)
on tr /r:c5 a fiislE-Z . in '#7(/ ,N.C.
(Waterbody) (Town and/or County)
He has described to me as shown in the attached application and project drawing(s),the development he is
proposing at that location,and,I have no objections to his proposal.
(APPLICATION AND DRAWING OF PROPOSED DEVELOPMENT ATTACHED)
ature
Print or Type Name
5i) 7m'?ff
Telephone Number
107 � //
Da e
RECEIVED
DEC 2 0 2011
')CM WILMINGTON, NC

Receipts for
Certified Mail
(Staple Here)
c.
le
f
Ad acent Property Owner
s
Mil g remiss 2 b'"z7/
City, State,Zip Code
Dear Adjacent Properly: /,
This letter is to inform you that I, C-/Qft/�4NP CA/a/. /`+ii'/Z c-lciyrlpplied for a CAMA Minor
Property Owner
Permit on my property at �4G /7f/� � C7;5e1 C:t,,� A/C. in COUNTY
Properly Address
County, As required by CAMA regulations, I have enclosed a copy of my permit application and project
drawing(s)as notification of my proposed project. No action is required from you or you may sign and return
the enclosed no objection form, If you have any questions or comments about my proposed project,please
contact me at ,or by mail al the address listed below. If you wish to
Applicant's Telephone
file written comments or objections with the LOCAL GOVERNMENT CAMA Minor Permit Program,you may submit
them to: 0/ / g/L
c-T t M G La r/ ,��� i'r c1 e2- c/Tr
/A 7 C- 17RD/nuNI IJ;?/va
L 2/ /r//N r0 NG -2,2s 4/
Sincerely, ,/
a/4 aj /4 N D Cc,4/e X44,e
Property Owner
Oi9N r G./9M�
Mailing Address
sS,,QX a 42,egfe i pg
City, State,Zip Code
RECEIVED
DEC 2 8 2011
DCM WILiV111VGTCN, NC

U. . •os a ervicein
CERTIFIED MAIL„., RECEIPT
(Domestic Mail Only;No Insurance Coverage Provided)
For delivery information visit our website at www.usps.com
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(Endorsement Required)
D Total Postage&Fees $ L . 2.__
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Sent To 106.51,‘
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Street,
eet,Apt .;
ortrPO Box No. al .601X &lc
City,State,ZIP+ Ijci

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'S Form 3800,August 2006(Reverse)PSN 7530-02-000-9047

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
FOR CAMA MINOR PERMITS
I hereby certify that 1 own property adjacent toC./A Ali•Jp Cat a/.
(Name of Property Owner)
property located at /Q A / G.P/ C_ r.
Address, Lot, Block, Road, etc.)
on ‘341fet"_:,S. C.,_hAr).v,4 , in 6 Ct R.. $ C /Tr , N.C.
(Waterbody) (Town andlor County •
He has described to me as shown in the attached application and project drawing(s), the development he is
proposing at that location, and, I have no objections to his proposal.
(APPLICATION AND DRAWING OF PROPOSED DEVELOPMENT ATTACHED)
Signature
Print or Type Name
Telephone Number
Date
•
RECEIVED
DEC 2 8 2011
PCM WILMINGTON, NC

Fay. Taaenity Prevatte Roglotar of peach
11-22-2011 13:10:20.000 Pander County, NC
"C RfVENUR STAMP: $450,ee t$t330aa)
(023-(01 r iS9u
k' a-11 • -i IJIIIJ! IlJIIIIl PO311 ;�-fs. „utyRey�r•ache P ��r D Y revatte PRep
page 1 of 3
NORTH CAROLINA GENERAL WARRANTY DEED
(4.1Z)
Excise
Parcel 1, D. 4223-69-1874-0000
Brief Descript- n ' e index: Lot 16,Cedar Point
Prepared by: an Rizzo,Attorney
Mail/Hold after.recording to: Grantee
THIS DEED,made this 27th day of October,2011, by and between
JIMMY A. PIERCE,Unmarried
GRANTOR, having an address of: Post Office Box 2704, Surf City, NC 28445
And
CLARK L. HARVEY AND WIFE,CAROLE E. HARVEY
GRANTEE,having an address of: 204 Janice Lane, Saxonburg, PA 16056
[The designation Grantor and Grantee as used herein shall include said parties,their heirs,successors,and assigns,and shall
include singular, plural.masculine, feminine or neuter as required by context.]
WITNESSETH, that the Grantor, for a valuable consideration paid by the Grantee,the receipt of which is hereby
acknowledged, has and by these presents does grant, bargain, sell and convey unto the Grantee in fee simple, all
that certain lot or parcel of land situated in Topsail Township, Fender County, North Carolina, and more
particularly described as follows:
See attached Exhibit "A"attached hereto and made a part hereof by reference.
The property hereinabove described was acquired by Grantor by instrument recorded in Book 2587, at Page
127, Pender County Registry,North Carolina.
DEC 2 8 2011
5CM WILMINGTON, NC.

ArtA
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue James H.cregson Dee Freeman
Governor Director Secretary
AGENT AUTHORIZATION FORM
Name of Property Owner Applying for Permit: Name of Authorized Agent for this project:
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Owner's Mailing Address: Agent's Mailing Address:
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Phone Number(7-�5') Phone Number(chn 3 81 - 7"?<7,
I certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
for and obtaining all CAMA Permits necessary to install or construct the following (activity):
(my property located) at / i6 el,47/ C 'Tl',4' C
This certification is valid thru (date) c. .1/
/?12 / ey/
Property Cl ner Signature Date
/6-2-/ ,2�. of,� CEIVED
DEC 2 8 2011
iCIMM 'WILMINGTON, NC
127 Cardinal Drive Ext.,Wilmington,NC 28405 One
Phone:[phone] FAX:[phone] Internet:www.nccoastalmanagement.net CIOEthC ro ina
Ar,E9uai OpporWniiy 1 ANfrmative Action Employer :Naturally ly

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HomeCo Builders, Inc. % RBC Bank
RBC Bank(USA)
14131 NC HWY 50
P.SURFOCITBOX Y,,NC704 8445 66-85-531 12/23/2011
[phone]
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PAY TO THE NCDENR $ **100.00 0
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RBC Bank®
HomeCo Builders, Inc. % RBC Bank(USA)
14131 NC HWY 50
P.SURFOCITY,,NC704 28445 66-85 531 12/23/2011
[phone] 8
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Hirk-WV /PA)
AFFIDAVIT OF PUBLICATION
STATE OF NORTH CAROLINA
COUNTY OF NEW HANOVER
CAMA MINOR PERMIT NOTICE Before the undersigned,a Notary Public of Said County and State,
Pursuant to NCGS 113A-119(b), the
North Carolina Division of Coastal
Management,an agency authorized Keith Raffone
to issue A permits in areas o
environmental concern, hereby
201gives
NOTTIC o lowin that g Deceem2pbl ric 2s Who,being duly sworn or affirmed,according to the law,says that he/she is
each applied for a CAMA permit to
construct a single-family dwelling
adjacent to a canal off Topsail Controller
Sound, in Surf City, Pender County:
Clark & Carole Harvey at 106 Abi-
gail Ct., and Zachary & Susan,, of THE STAR-NEWS, a corporation organized and doingbusiness under the Laws of the State of
Salmon at 108 Abigail Ct. And on p g
December 30, 201.2, the Town of North Carolina,and publishing a newspaper known as STAR-NEWS in the City of Wilmington
Wrightsville Beach applied for-a
CAMA permit to add curbing to the
lot entrances at 2498 & 2698 N. CAMA MINOR PERMIT NOTICE Pursuant to NCGS 113A-119b, the North Carolina Division
Lumina Avenue, adjacent to the At-
' lantic Ocean, in Wrightsville Beach, of Coastal Management,an agency authorized to issue CAMA permits in areas of
New Hanover County. The applica- environmental concern, herebygives NOTICE that on December 28,2011 the following 2
tions may be inspected at the ad-
dress
below. Public comments re- applicants
ceived by January 21, 2012 will be
considered. Later comments will be
accepted and considered up to the
time of permit decision. Project
modifications may occur based on
further review and comments. No-
tice of the permit decision in this
matter will be provided upon writ-
ten request, was inserted in the aforesaid newspaper in space,and on dates as follows:
Jason Dail,Field Representative for
Surf City,Phone:[phone]
Robb Mairs,Field Representative for 1/6 lx
Wrightsville Beach
Phone:[phone]
Division of Coastal Management
127 Cardinal Drive Extension
Wilmington, NC 28405-3845 And at the time of such publication Star-News was a newspaper meeting all the requirements and
qualifications prescribed by Sec. No. 1-597 G.S. of N.C.
10/ Title: Controller ��`�Q.�G O
Sworn or affirmed to, an bscribed before me this `� of QTA ti
J/"J.t 'tJjj ,A.D., it _ N R�' '33s
In Testimonythereof,I have hereunto set my hand and affixed my itticial sal,the day and Li
year aforesaid.
L ' "'h' otU) ublic
My commission expires day of ,20_ Ir4Y COMMISSION EXPIRES 911212012
Upon reading the aforegoing affidavit with the advertisement thereto annexed it is adjudged by the Court that the said
publication was duly and properly made and that the summons has been duly and legally served on the defendant(s).
This day of
Clerk of Superior Court
MAIL TO: