NCC200813_Contact Update Record_20210422

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Georgoulias, Bethany 4/22/2021 1:00:03 PM (Contact Changes Submitted)

Certificate of NCC200813
Coverage (COC) Enter the Certificate of Coverage Ninber (Use capital letters)
No.*
NC Reference No. NCG01-2020-0813
Original NOI No.* 22544
Project information associated with this permit (cannot change):
Permittee Listed Crganizaitoncannot bechanged (new OOCrequired)
Venn Hillsborough, LLC
Project Name
Courtyards at Magnolia Glen, Phase 2
Address
Old Hillsborough Road, Mebane, NC
County
Alamance
Latitude
36.0570
Longitude
-79.2820
Date COC Issued*
03/05/2020
Prior Rescission
This field will populate only if COChas already been rescinded.
Date
Which Contacts
f Billing Only
Have Changed?*
f Legally Responsible Individual Only
f Site Contact Only
r BOTH Legally Responsible Individual and Site Contact
Has Billing Contact
Choose'Yes'torevise Billing Contact details.
Changed?
r No
r Yes
Billing Email
NEW Billing Email ([e-mail]
Billing Telephone
No.
NEW Billing (Optional)
Telephone No.
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible Shawn Cummings
Individual
(Previous)

First Name (New)* Shavvn
Last Name (New) * Cummings
NEW Legally Peflects any revisions above
Responsible Shawn Cummings
Individual*
Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee 336-675-2417
Telephone No.
(Previous)
NEW Permittee 336-675-2417
Telephone No.*
Permittee Mailing P.O. Box677, 226 HIGHLAND DR, Elon, NC
Address (Previous) 27215
NEW Permittee Street Address
Mailing Address* P.O. Box667
Address Line 2
City
State / Rovince / Fbgion
Elon
NC
Fbstal / Zip Code
Country
27244
United States
Permittee Street 1844 Buxton Way, 0, Burlington, NC 27215
Address (Previous)
NEW Permittee Street Address
Street Address* 3041 S Church Street
Address Line 2
City State / Fkovince / Region
Burlington NC
Fbstal / Zip Code Country
27215 United States
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact
Shawn Cummings
(Previous)
Site Contact Title
Managing Member
(Previous)
Organization
Venn Hillsborough, LLC
(Previous)
First Name (New)*
Shawn

Last Name (New) * Cummings
NEW Site Contact* Peflects any revisions above
Shawn Cummings
NEW Site Contact Managing Member
Title
NEW Organization Venn Hillsborough, LLC
This field is not required on the NOI form and nay not pre -populate.
Site Contact Email [e-mail]
(Previous)
NEW Site Contact [e-mail]
Email*
Site Contact 336-675-2417
Telephone No.
(Previous)
NEW Site Contact 336-675-2417
Telephone No.*
Site Contact Mailing P.O. Box 677, 0, Elon, NC 27244
Address (Previous)
NEW Site Contact Street Address
Mailing Address* P.O. Box667
Address Line 2
City
State / Rovince / Fbgion
Elon
NC
Fbstal / Zip Code
Country
27244
United States
Change Requested Lisa Brewer via e-mail on 4/20/2021
by: * Include any additional correspondence records in the Fbpository 00Cfolder.
Additional Information for this update to contact information:
Addional Permittee street address and PO Box number in mailing addresses needed
Explanation correction.
(Optional)
Date * 04/22/2021