1b_73510070_997053a6b9fb435ca809e6260805123a

0 AMENDED LIMITED LIABILITY COMPANY ANNUAL REPORT
1/s/zozz
NAME OF LIMITED LIABILITY COMPANY: Coastal Land and Sand Company, LLC
Filing Office Use Only
SECRETARY OF STATE ID NUMBER: 1031870 STATE OF FORMATION: NC E-Filed Annual Report
AMENDING DOC ID 1031870
REPORT FOR THE CALENDAR YEAR: 2023 # CA2023 6/29/2023 1 0675
10:45
SECTION A: REGISTERED AGENT'S INFORMATION Changes
1. NAME OF REGISTERED AGENT: Cernugel, Samuel J
2. SIGNATURE OF THE NEW REGISTERED AGENT:
SIGNATURE CONSTITUTES CONSENT TO THE APPOINTMENT
3. REGISTERED AGENT OFFICE STREET ADDRESS&COUNTY 4. REGISTERED AGENT OFFICE MAILING ADDRESS
1292 Riverbend Drive 1292 Riverbend Drive
Shallotte, NC 28470 Brunswick County Shallotte, NC 28470
SECTION B: PRINCIPAL OFFICE INFORMATION
1. DESCRIPTION OF NATURE OF BUSINESS: Investment
2. PRINCIPAL OFFICE PHONE NUMBER: [phone] x 3. PRINCIPAL OFFICE EMAIL: Privacy/ Redaction
4. PRINCIPAL OFFICE STREET ADDRESS 5. PRINCIPAL OFFICE MAILING ADDRESS
1292 Riverbend Drive 1292 Riverbend Drive
Shallotte, NC 28470 Shallotte, NC 28470
6. Select one of the following if applicable. (Optional see instructions)
❑ The company is a veteran-owned small business
❑ The company is a service-disabled veteran-owned small business
SECTION C: COMPANY OFFICIALS(Enter additional company officials in Section E.)
NAME: Samuel J. Cernugel NAME: Mary Brown Jackson NAME:
TITLE: Managing Member TITLE: Member TITLE:
ADDRESS: ADDRESS: ADDRESS:
1292 Riverbend Drive P O Box 3364
Shallotte, NC 28470 North Myrtle Beach,SC 29582
SECTION D: CERTIFICATION OF ANNUAL REPORT. Section D must be completed in its entirety by a person/business entity.
Mary Brown Jackson 6/29/2023
SIGNATURE DATE
Form must be signed by a Company Official listed under Section C of This form.
Mary Brown Jackson Member
Print or Type Name of Company Official Print or Type Title of Company Official
This Annual Report has been filed electronically.
MAIL TO:Secretary of State, Business Registration Division,Post Office Box 29525,Raleigh,NC 27626-0525