NCC191290_Annual Fee Payment Record_20201112

Action History (UTC-05:00) Eastern Time (US & Canada)
by Workflow 11/10/2020 7:00:09 AM (Workflow Start Event)
Submit by Selkane, Aziza 11/12/2020 10:06:34 AM (Annual Fee Payment Verification for NCC191290-2020)
* GHA Autism Supports
• Selkane, Aziza assigned the task to Selkane, Aziza 11/12/2020 10:05 AM
The task was assigned to DEMLR NCG01 Annual Fee Team. The due date is: December 22, 2020 5:00
PM 11/10/2020 7:00 AM

SfA7$ q,
NORTH CAROLINA
Envlrmmentuf Quuftty
Certificate of
NCC191290
Coverage (COC)
This is passed fromtheworKlowwhen the invoice isfiled.
No. *
NC Reference COC
NCG01-2019-1290
No.*
Permit Status:
Active
Project Name *
GHA-Farm
Project Address*
Morrow Mountain Road, Albemarle, NC
Permittee *
GHA Autism Supports
County
Stanly
Invoice No.*
NCC191290-2020
This is passed fromthe worldlow when the invoice is filed.
Annual Fee *
$ 100.00
Invoice Date*
11/10/2020
This is passed fromthe worldlow when the invoice is filed.
Invoice Due Date *
12/10/2020
This is passed fromthe woMlow when the invoice is filed.
An automated email reminder is sent to the permittee when the invoice is due. Wait until invoice is 15 days overdue
before proceeding to a Notice of Deficiency.
Important: If you change the choice below to Payment NOT RECEIVED, the fee status becomes PAST DUE, and the
permittee will receive a Notice of Deficiency.
Annual Fee Payment r Fee Payment Received or Not Applicable.
Received* r Fee Payment NOT RECEIVED.
Date Payment 11/12/2020
Received * Or, if WAIVBD or NOT FECBV®, this is the date that status is recorded.
Method of Payment* r electronic
f check
f other
ePayment 544193414
Transaction
Number*
Fee Status* PAID
Legally Responsible Dawn Allen
Person (Orig.)

Original Permittee E- [e-mail]
mail *
CONFIRM Permittee [e-mail]
E-mail * Opportunity to rrodify problem e-mail address or perrrittee contact info
Original Site Contact [e-mail]
E-mail *
CONFIRM Site [e-mail]
Contact E-mail * Opportunity to correct problem e-rrail address or site contact info
Additional Billing Contact E-mails
Additional E-mail for
CC:
Review Date * 11/12/2020