NTB_16-32_CBL Custom Homes Inc.

Coastal Management
ENVIRONMENTAL QUALITY
November 23, 2016
CLB Custom Homes, Inc. C/o Chris Barnes
105 Kinsey Court
Hampstead, NC 28443
PAT MCCRORY
Gommor
DONALD R. VAN DER VAART
Secretary
BRAXTON DAVIS
Director
RE: EXEMPTED PROJECT (MINORS) SINGLE FAMILY RESIDENCES WITHIN THE
ESTUARINE SHORELINE AREA OF ENVIRONMENTAL CONCERN (15A NCAC 07K
.0208). - NTBEXI6-32
PROJECT LOCATION/ADDRESS -107 Old Village Lane, North Topsail Beach, NC
Dear Mr. Barnes:
I have reviewed the information you submitted to our office concerning the necessary filing of an
application for a CAMA Minor Development Permit under the Coastal Area Management Act and have
determined that the activity you propose is exempt from needing a CAMA Minor Development Permit as
long as it remains consistent with your project drawings and paperwork, dated received November 23,
2016, and it also meets the conditions specified below. If you plan(s) should change and your project will
no longer meet these conditions, please contact me before proceeding.
SINGLE FAMILY RESIDENCES WITHIN THE ESTAURINE SHORELINE AREA OF
ENVIRONMENTAL CONCERN EXEMPTED
1. All development shall be located at least 40 feet of the mean high water mark or normal water
level from waters classified as ORW.
2. No ground disturbance or land disturbing activity shall occur within 40 feet of the mean high
water mark or normal water level from waters classified as ORW.
3. The development may not exceed a 25% built upon area within 575 feet of the mean high water
mark or normal water level of waters classified as ORW, and shall not include any stornwatet,
collection system. Construction of the "proposed pervious drive" shall be limited to #57
stone, at a thickness of 4"-6" spread over a base layer of filter fabric. No other type of
material shall be used without prior authorization from the NC Division of Coastal
Management.
4. The development shall be consistent with all other applicable CAMA permit standards, North
Carolina Building Code standards, local ordinances and local land use plans in effect at the time
the exemption is granted.
5. This authorization does not allow for any disturbance to any wetlands or open water areas.
Any proposal to modify or alter the development plan as proposed will require additional
authorization from the Division of Coastal Management.
This exemption to CAMA permit requirements does not alleviate the necessity of your obtaining any
other State, Federal or Local authorization. This exemption expires one (1) year from the date of the
letter.
Sincerely,
Jason Dail, LPO
Cc: DCM - WIRO
NT 3 - Telrie Woodle
State of North Carolina I Environmental Quality I Coastal Management
127 Cardinal Drive E#., Wilmington, NC 28405
910-796-7215

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PREUMINARY PLOT PLAN
CHARLES F. RIGGS & ASSOCIATES, INC. (C-780) FOR
LAND SURVEYING - CONVENTIONAL & GLOBAL POSITIONING SYSTEMS, CLB CUSTOM HOMES, INC.
LAND PLANNING & COMPUTER MAPPING LOT 7, SECTION 2, VILLAGE OF STUMP SOUND, M.B. 27, P. 111
502 NEW BRIODE STREET LANOFAII EXECUTIVE SUITE 217 STUMP SOUND TOWNSHIP, ONSLOW COUNTY, NORTH CAROLINA
P.O. BOX ISM 1213 WIBRETV DRIVE TOPS VENTURES, LLC & PAUL R. DORADO, OWNERS, D.B. 2281, P. 553
JACKSONWLLE, NO 285M-1570 MWINOTON. NO 2BTU5 105 OLD VILLAGE LANE
TELEPHONE: (910) t55-OB77 TELEPHONE: [phone]
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ACTUAL FIELD SURVEY OATS OCTOBER 25. 2016
MAPPING DAIS: OCTOBER 27, 2016
FIELD BOOK: 949 PAGE: _ `�

V E U U.S. ARMY CORPS OF ENGINEERS
hjC iVl WILMINGTON, NC WILMINGTON DISTRICT
Action Id. SAW-2016-02139 County: Onslow U.S.G.S. Quad: NC-SPICER BAY
NOV 2 b 1016
NOTIFICATION OF JURISDICTIONAL DETERMINATION
Property Owner/Applicant: Paul Thomas Dorazio Agent: Charles Riess
PO Box 638 PO Box 1570
Sneads Ferry, NC 28460 Jacksonville, NC 28541
Size (acres) 0.48 Nearest Town North Topsail Beach
Nearest Waterway Onslow Bav River Basin Stump Sound
USGS HUC 03020302 Coordinates Latitude: 34.4546624052142
Longitude:-77.4993355227921
Location description: The project area consists of Lots 7 and 8 located at 105 and 107 Old Villaee Lane North Topsail
Beach, Onslow County, North Carolina.
Indicate Which of the Following Apply:
A. Preliminary Determination
There are waters, including wetlands, on the above described project area, that may be subject to Section 404 of the
Clean Water Act (CWA)(33 USC § 1344) and/or Section 10 of the Rivers and Harbors Act (RHA) (33 USC § 403). The
waters, including wetlands, have been delineated, and the delineation has been verified by the Corps to be sufficiently
accurate and reliable. Therefore this preliminaryjurisdiction determination may be used in the permit evaluation process,
including determining compensatory mitigation. For purposes of computation of impacts, compensatory mitigation
requirements, and other resource protection measures, a permit decision made on the basis of a preliminary JD will treat all
waters and wetlands that would be affected in any way by the permitted activity on the site as if they are jurisdictional
waters of the U.S. This preliminary determination is not an appealable action under the Regulatory Program
Administrative Appeal Proress (Reference 33 CFRPart 331). However, you may request an approved JD, which is an
appealable action, by contacting the Corps district for further instruction.
There are wetlands on the above described property, that may be subject to Section 404 ofthe Clean Water Act
(CWA)(33 USC § 1344) and/or Section 10 of the Rivers and Harbors Act (RHA) (33 USC § 403). However, since the
waters, including wetlands, have not been properly delineated, this preliminary jurisdiction determination may not be
used in the permit evaluation process. Without a verified wetland delineation, this preliminary determination is merely an
effective presumption of CWA/RHA jurisdiction overall of the waters, including wetlands, at the project area, which is
not sufficiently accurate and reliable to support an enforceable permit decision. We recommend that you have the
waters of the U.S. on your property delineated. As the Corps may not be able to accomplish this wetland delineation in a
timely manner, you may wish to obtain a consultant to conduct a delineation that can be verified by the Corps.
B. Approved Determination
_ There are Navigable Waters of the United States within the above described property subject to the permit requirements of
Section 10 of the Rivers and Harbors Act (RHA) (33 USC § 403) and Section 404 of the Clean Water Act (CWA)(33 USC
§ 1344). Unless there is a change in law or our published regulations, this determination may be relied upon for a period
not to exceed five years from the date of this notification.
There are waters of the U.S., including wetlands, on the above described project area subject to the permit requirements
of Section 404 of the Clean Water Act (CWA) (33 USC § 1344). Unless there is a change in the law or our published
regulations, this determination may be relied upon for a period not to exceed five years from the date of this notification.
We recommend you have the waters of the U.S. on your property delineated. As the Corps may not be able to
accomplish this wetland delineation in a timely manner, you may wish to obtain a consultant to conduct a delineation that
can be verified by the Corps.
Page 1 of 2

SAW-2016-42139
_ The waters of the U.S., including wetlands, on your project area have been delineated and the delineation has been
verified by the Corps. If you wish to have the delineation surveyed, the Corps can review and verify the survey upon
completion. Once verified, this survey will provide an accurate depiction of all areas subject to CWA and/or RHA
jurisdiction on your property which, provided there is no change in the law or our published regulations, may be relied
upon for a period not to exceed five years.
X The waters of the U.S., including wetlands, have been delineated and surveyed and are accurately depicted on the
plat signed by the Corps Regulatory Official identified below on 11/21/16. Unless there is a change in the law or our
published regulations, this determination may be relied upon for a period not to exceed five years from the date of this
notification.
There are no waters of the U.S., to include wetlands, present on the above described project area which are subject to the
permit requirements of Section 404 of the Clean Water Act (33 USC 1344). Unless there is a change in the law or our
published regulations, this determination may be relied upon for a period not to exceed five years from the date of this
notification.
The property is located in one of the 20 Coastal Counties subject to regulation under the Coastal Area Management Act
(LAMA). You should contact the Division of Coastal Management in Morehead City, NC, at [phone] to
determine their requirements.
Placement of dredged or fill material within waters of the US, including wetlands, without a Department of the Army permit
may constitute a violation of Section 301 of the Clean Water Act (33 USC § 1311). Placement of dredged or fill material,
construction or placement of structures, or work within navigable waters of the United States without a Department of the
Army permit may constitute a violation of Sections 9 and/or 10 of the Rivers and Harbors Act (33 USC § 401 and/or 403). If
you have any questions regarding this determination and/or the Corps regulatory program, please contact Brennan Dooley at
910-251-4694 or Brennan.J.Dooley(alusace.army.mil.
C. Basis For Determination: The protect area exhibits wetland criteria as described in the 1987 Corps Wetland
Delineation manual and is abutting tidal wetlands alone Stump Sound, a navigable water of the US.
D. Remarks:
E, Attention USDA Program Participants
This delineation/determination has been conducted to identify the limits of Corps' Clean Water Act jurisdiction for the
particular site identified in this request. The delineation/determination may not be valid for the wetland conservation
provisions of the Food Security Act of 1985. If you or your tenant are USDA Program participants, or anticipate participation
in USDA programs, you should request a certified wetland determination from the local office of the Natural Resources
Conservation Service, prior to starting work
F. Appeals Information (This information applies only to approved jurisdictional determinations as indicated in
B. above)
This correspondence constitutes an approved jurisdictional determination for the above described site. If you object to this
determination, you may request an administrative appeal under Corps regulations at 33 CFR Part 331. Enclosed you will find a
Notification of Appeal Process (NAP) fact sheet and request for appeal (RFA) form. If you request to appeal this
determination you must submit a completed RFA form to the following address:
US Army Corps of Engineers
South Atlantic Division
Attn: Jason Steele, Review Officer
60 Forsyth Street SW, Room 1 OM15
Atlanta, Georgia 30303-8801
DGiJi WILMINGTON, NCB
I"0 V 2 ;; 2016
In order for an RFA to be accepted by the Corps, the Corps must determine that it is complete, that it meets the criteria for
appeal under 33 CFR part 331.5, and that it has been received by the Division Office within 60 days of the date of the NAP.
Should you decide to submit an RFA form, it must be received at the above address by 1/19/16.
**It is not necessary to submit an RFA form to the Division Office if you do not object to the determination in this
correspondence.**
Page 2 of 2

Corps Regulatory Official:
Date: November 21.2016 Expiration Date: November 21, 2021
The Wilmington District is committed to providing the highest level of support to the public. To help us ensure we
continue to do so, please complete our Customer Satisfaction Survey, located online at
http://corpsmat)u.usace.A=.mil/cm apex/f?p=136*0.
c JED
„u,J 'VVILM NGTON, NC
110V 2S2016
Page 3 of 2

Paul Thomas Dorazio I File Number: SAW-2016-02139
Attached is:
�� INITIAL PROFFERED PERMIT (Standard Permit or Letter of permission) A
PROFFERED PERMIT (Standard Permit or Letter of Permission) i B
E
e Q td ur $ an" p runs regardg a atl.,& 1 of tfie
o 9jla Vl vw usace. army.miUMrssrd - orksIke 2ulatorvProaramand i?tt5
A: INITIAL PROFFERED PERMIT: You may accept or object to the permit.
• ACCEPT: If you received a Standard Permit, you may sign the permit document and return it to the district engineer for final
authorization If you received a Letter of Permission (LOP), you may accept the LOP and your work is authorized. Your
signature on the Standard Permit or acceptance of the LOP means that you accept the permit in its entirety, and waive all
rights to appeal the permit, including its terms and conditions, and approved jurisdictional determinations associated with the
permit.
• OBJECT: If you object to the permit (Standard or LOP) because of certain terms and conditions therein, you may request
that the permit be modified accordingly. You must complete Section If of this form and return the form to the district
engineer. Your objections must be received by the district engineer within 60 days of the date of this notice, or you will
forfeit your right to appeal the permit in the future. Upon receipt of your letter, the district engineer will evaluate your
objections and may: (a) modify the permit to address all of your concerns, (b) modify the permit to address some of your
objections, or (c) not modify the permit having determined that the permit should be issued as previously written. After
evaluating your objections, the district engineer will send you a proffered permit for your reconsideration, as indicated in
Section B below.
B: PROFFERED PERMIT: You may accept or appeal the permit
• ACCEPT: If you received a Standard Permit, you may sign the permit document and return it to the district engineer for final
authorization. If you received a Letter of Permission (LOP), you may accept the LOP and your work is authorized. Your
signature on the Standard Permit or acceptance of the LOP means that you accept the permit in its entirety, and waive all
rights to appeal the permit, including its terms and conditions, and approved jurisdictional determinations associated with the
permit.
• APPEAL: If you choose to decline the proffered permit (Standard or LOP) because of certain terms and conditions therein,
you may appeal the declined permit under the Corps of Engineers Administrative Appeal Process by completing Section 11 of
Us form and sending the form to the division engineer. This form must be received by the division engineer within 60 days
of the date of this notice.
C: PERMIT DENIAL: You may appeal the denial of a permit under the Corps of Engineers Administrative Appeal Process by
completing Section II of this form and sending the form to the division engineer. This form must be received by the division
engineer within 60 days of the date of this notice.
D: APPROVED JURISDICTIONAL DETERMINATION: You may accept or appeal the approved JD or provide new
information.
• ACCEPT: You do not need to notify the Corps to accept an approved JD. Failure to notify the Corps within 60 days of the
date of this notice, means that you accept the approved JD in its entirety, and waive all rights to appeal the approved JD.
• APPEAL: If you disagree with the approved JD, you may appeal the approved JD under the Corps of Engineers
Administrative Appeal Process by completing Section II of this form and sending the form to the district engineer. This form
must be received by the division engineer within 60 days of the date of this notice.
i �i✓ WILMINGTON, NC
Page 4 of Z ro
I:OV L o 2316

E: PRELIMINARY JURISDICTIONAL DETERMINATION: You do not need to respond to the Corps regarding the
preliminary JD. The Preliminary JD is not appealable. If you wish, you may request an approved JD (which may be appealed),
by contacting the Corps district for further instruction. Also you may provide new information for further consideration by the
Corps to reevaluate the JD.
REASONS FOR APPEAL OR OBJECTIONS: (Describe your reasons for appealing the decision or your objections to an initial
proffered permit in clear concise statements. You may attach additional information to this form to clarify where your reasons or
objections are addressed in the administrative record.)
ADDITIONAL INFORMATION: The appeal is limited to a review of the administrative record, the Corps memorandum for the
record of the appeal conference or meeting, and any supplemental information that the review officer has determined is needed to
clarify the administrative record. Neither the appellant nor the Corps may add new information or analyses to the record.
However, you may provide additional information to clarify the location of information that is already in the administrative
record.
If you have questions regarding this decision and/or the
appeal process you may contact:
District Engineer, Wilmington Regulatory Division,
Attn: Brennan Dooley
69 Darlington Avenue
Wilmington, NC 28403
If you only have questions regarding the appeal process you may
also contact:
Mr. Jason Steele, Administrative Appeal Review Officer
CESAD-PI)O
U.S. Army Corps of Engineers, South Atlantic Division
60 Forsyth Street, Room 1OM15
Atlanta, Georgia 30303-8801
Phone: [phone]
RIGHT OF ENTRY: Your signature below grants the right of entry to Corps of Engineers personnel, and any government
consultants, to conduct investigations of the project site during the course of the appeal process. You will be provided a 15 day
notice of any site investiP-ation, and will have the opportunity to participate in all site investigations.
Telephone number:
For appeals on Initial Proffered Permits send this form to:
District Engineer, Wilmington Regulatory Division, Brennan Dooley,
For Permit denials, Proffered Permits and approved Jurisdictional Determinations send this form to:
Division Engineer, Commander, U.S. Army Engineer Division, South Atlantic, Attn: Mr. Jason Steele,
Administrative Appeal Officer, CESAD-PDO, 60 Forsyth Street, Room 10M15, Atlanta, Georgia 30303-8801
Phone: [phone]
WILMINGTON, N.0
Page 5 of 2

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LAND SURVEYING - CONVENTIONAL & GLOBAL POSITIONING SYSTEMS, CLB CUSTOM HOMES, INC. c)R OD PLANNING & COMPUTER MMPING t inch - 2O R
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502 NEW BRIDGE STREET LANDFALL EXECUTIVE SUITE 217 LOT 8, SECTION 2, VILLAGE OF STUMP SOUND, M.B. 27, P. 111 ACTUAL FIELD SURVEY DATE: OCTOBER 25. 261E
P.O. BOX 15M 1213 OWUIW H DRIVE STUMP SOUND TOWNSHIP, ONSLOW COUNTY, NORTH CAROLINA MAPPING DATE: NOVEMBER 7, 2019
AO \MIF NC 28510-1570 M9AINoTo14 NC 2910E TOPS VENTURES, LLC & PAUL DORAZIO, OWNERS, D.B. 2281. P. WFIELD B - mPACE: i_
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OFFER TO PURCHASE AND CONTRACT - VACANT LOT4 AND
tConsuit "Guidelines" (fort 12G) for guidance in completing this form]
NOTE: This contract is intended for unimproved real property that Buyer will purchase only for personal use and does not have
immediate plans to subdivide. It should not be used to sell property that is being subdivided unless the property has been platted,
property approved and recorded with the register of deeds as of the date of the contract. If Seller is Buyer's builder and the sale
involves the construction of a new single family dwelling prior to closing, use the standard Offer to Purchase and Contract —New
Construction (Form 800-T) or, if the construction is completed, use the Offer to Purchase and Contract (Form 2-T) with the New
Construction Addendum (Form 2A3-T).
For valuable consideration, the receipt and legal sufficiency of which are hereby acknowledged, Buyer ofters to purchase and Seller
upon acceptance agrees to sell and convey the Property on the terms and conditions of this Offer To Purchase and Contract and any
addendum or modification made in accordance with its terms (together the "Contract").
1. TERMS AND DEFINITIONS: The terms listed below shall have the respective meaning given them as set forth adjacent to each
term.
(a) "Seller': Tops ventures ui;,
(b) `Buyer":CLD Custom homes Inc.
(c) "Property": The Property shall include all that real estate described below together with all appurtenances thereto including the
improvements located thereon. NOTE: If the Property will include a manufactured (mobile) home(s), Buyer and Seller should
consider including the Manufactured (Mobile) Home provision in the Additional Provisions Addendum (Standard Fort 2AI I-T)
with this offer.
Street Address: 107 Old Village Lane
(NOTE' Governmental authority over taxes, zoning, school districts, utilities and mail delivery may differ from address shown.)
Legal Description: (Complete ALL applicable)
Plat Reference: LoUUnite , Block/Section , Subdivision;Condominium village of Stump Sound 2
as shown on Plat Book/Slide at Page(s)
The PIN/PID or other identification number of the Property is: 806-106
Other description: L.8 S2 VlilgStmp Snd S/F 7501,2
Some or all of the Property may be described in Deed Book 27 at Page Ill
(d) "Purchase Price".
paid in U.S. Dollars upon the following terms:
row BY DUE DILIGENCE FEE made payable and delivered to Seller by the Effective
Date
BY INITIAL EARNEST MONEY DEPOSIT made payable and delivered to Escrow
Agent named in Paragraph HD by ❑ cash ❑ personal check ❑ official bank check
❑ wire transfer, ❑ electronic transfer, EITHER ❑ with this offer OR ❑ within five
(5) days of the Effective Date of this Contract.
S BY (ADDITIONAL) EARNEST MONEY DEPOSIT made payable and delivered to
Escrow Agent named in Paragraph 1(t) by cash in immediately available funds such
as official bank check, wire transfer or electronic transfer no later than
TIME
BEING OF THE E,RSENCE with regard to said date.
S BY ASSUMPTION of the unpaid principal balance and all obligations of Seller on
the existing Insults) secured by a deed of trust on the Property in accordance with the
attached Loan Assumption Addendum (Standard Form 2A6-T).
S BY SELLER FINANCING in accordance with the attached Seller Financing
Addendum (Standard Form 2A5-T).
BALANCE of the Purchase Price in cash at Settlement (some or all of which may be
paid with the proceeds of a new loan)

NOTE: INSERT THE ADDRESS AND/OR ELECTRONIC DELIVERY ADDRESS EACH PARTY AND AGENT APPROVES
FOR THE RECEIPT OF ANY NOTICE CONTEMPLATED BY THIS CONTRACT. INSERT "N/A" FOR ANY WHICH ARE
NOT APPROVED.
BUYER NOTICE ADDRESS:
SELLER NOTICE ADDRESS:
Mailing Address: 105 Kinsey court Mailing Address: Po Boa 638
Hampstead, NC 28443 Sneads Ferry, NC 2M60
Buyer Fax#:
Seller Fax#:
Buyer E-mail:[e-mail] Seller E-mailldenitns408@gmafi com
SELLING AGENT NOTICE ADDRESS:
LISTING AGENT NOTICE ADDRESS:
Firm Namc:Coldwell Banker Seacoast Advan a Firm Nanw:Coldwell Banker Seacoast Advmmge
Acting as © Buyer's Agent Seller's (sub)Agent 0 Dual Agent Acting as ❑ Seller's Agent 0 Dual Agent
Firm License #C9314 Firm License #.C9314
Mailing Address: 326 N New River Drive, Surf City, NC 28445 Mailing Address:326 N New River Drive, Surf City, NC 2M45
Individual Selling Agent: Pat Workman Individual Listing Agent: pat Workman
ClActing as a Designated Dual Agent (check only if applicable) O Acting as a Designated Dual Agent (check only if applicable)
Selling Agent License 0:288936
Selling Agent Phone#:[phone]
Selling Agent Fax#:
Selling Agent E-mail:[e-mail]
-, jED
WlLfq.I�V*GTON, NC
1.0V<,c�2M
Listing Agent License #288936
Listing Agent Phom#910795-0196
Listing Agent Fax#:
Listing Agent E-mail:panvorkman@seacoasuealtvxom
[THIS SPACE INTENTIONALLY LEFT BLANK]

amaop s�nn�,�eeuo�:+..w.a0000c.ia�.�r�.gro.rrtanGwnt..assswaaz.ta-zoos
to a patty herein, any any fee, deposit of other payment to be delivered to a party herein, may be givers to the party or to such parry's
agent. Seller and Buyer agree that the "Notice Information' and "Acknowledgment of Receipt of Monies" sections below shall not
constitute a material part of this Contract, and that the addition or modification of any information therein shall not constitute a
rejection of an offer or the creation of a counteroffer.
19. EXECUTION: This Contract may be signed in multiple originals or counterparts, all of which together constitute one and the
same instrument.
20. COMPUTATION OF DAYSITIAIE OF DAY: Unless otherwise provided, for purposes of this Contract, the term "days' shall
mean consecutive calendar days, including Saturdays, Sundays, and holidays, whether federal, state, local or religious. For the
purposes of calculating days, the count of "days" shall begin on the day following the day upon which any act or notice as provided in
this Contract was required to he performed or made. Any reference to a date or time of day shall refer to the date and/or time of day in
the State of North Carolina.
TULNORTH CAROLINA ASSOCIATION OF REALTORS-, INC. AND THE NORTH CAROLINA BAR ASSOCIATION
NO REPRESENTATION AS TO TIIE LEGAL VALIDITY OR ADEQUACY OF ANY PROVISION OF THIS FORM IN
Pf SPECIFIC TRANSACTION. IF YOU DO NOT UNDERSTAND THIS FORM OR FEEL THAT IT DOES NOT PROVIDE
FOR YOUR LEGAL NEEDS, YOU SHOULD CONSULT A NORTH CAROLINA REAL ESTATE ATTORNEY BEFORE YOU
$JGN IT.
Obis offer shall become a binding contract on the Effective Date. Unless specifically provided otherwise, Buyer's failure to timely
deliver any fee, deposit or other payment provided for heroin shall not prevent this offer from becoming a binding contract, provided
that any such failure shall give Seller certain rights to terminate the contract as described herein or as otherwise permitted by law.
Date:
Buyer
Date:
Buyer
Entity Buyer:
CLB Custom Homes Inc.
erne of LLCICor oratiom'Partncmhi Tr ut/etc.
Fe
By:
Wkpala0..
Name: Christopher Barnes
Title: President
Date:
eet rv=lf
I;;,,; VVILlNidNGTON,
I:OV , r r,`I'l(
Date:
Seller
Date:
Seller
Entity Sella:
Toper Ventures, LLC
(Name of LI.C/CorporationTarmetshiprTrusVcte
� MMbywwpp...u�e
''__ RlIfN6ap��E�OT,�
Name:
Title: Parma
Date:
Page 9 of I l
STANDARD FORM 12-T
Revised 7/2016
V 7/2016