NCC216215_FRO Submitted_20211108

1 CITY OF GREENSBORO
FINANCIAL RESPONSIBI I.ITY OWNERSH'P FORM
SEDIMENTATION POLLUTION CONTROL ACT
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No person may initiate any land -disturbing activity covered by the Sedimentation Pollution Control Act before this form
has been completed and filed with the Sediment and Erosion Control Section of the City of Greensboro. (Please type
or print and, if questions are not applicable, place N/A in the blank).
Part A:
1. Project Name: P&G Confidential Project
2. Location of land -disturbing activity: 100 S. Swing Road, Greensboro, NC
3. Approximate date land disturbing activity will be commenced: Upon plan approval
4. Development type: Commercial Industrial ✓ Institutional_ MF residential SF residential
5. Approximate acreage of land to be disturbed: 10.49 Acres
6. Has an erosion and sediment control plan been fled? Yes ✓ No
7. Landowner(s) of Record (attach pages to list additional owners):
The Procter & Gamble Manufacturing Co.
Name
Attn: Tax Department
Current Mailing Address
Richardson TX 75081
City State Zip
513-780-2299 [e-mail]
Telephone Email
1 Procter & Gamble Plaza
Current Physical Street Address
Cincinnati OH 45202
City State
8. Deed County: Guilford Book: 7611 Page: 1722
9. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name: Tom Rogers
Telephone: [phone]
E-mail: [e-mail] Other:
Part B:
Zip
1. Company(ies) or firm(s) who are financially responsible for the land -disturbing activity (Provide a comprehensive
list of all responsible parties on an attached sheet.) If the company or firm is a sole proprietorship the name of the owner
or manager may be listed as the financially responsible party.
The Procter & Gamble Manufacturing Co.
Name
1 Procter & Gamble Plaza
Current Mailing Address
Cincinnati OH 45202
City State Zip
513-780-2299 [e-mail]
Telephone Email
1 Procter & Gamble Plaza
Current Physical Street Address
Cincinnati OH
City State
45202
Zip

2. (a) If the Financially Responsible Party is not a resident of North Carolina, give name and street address of the
designated North Carolina Agent:
CT Corporation System 888-724-9870
Name Telephone
160 Mine Lake Road
Current Mailing Address
Raleigh NC 27615
City State Zip
Email
160 Mine Lake Road
Current Physical Street Address
Raleigh NC 27615
City State Zip
(b) If the Financially Responsible Party is a Partnership or other person engaging in business under an assumed
name, attach a copy of the Certificate of Assumed Name. If the Financially Responsible Party is a Corporation,
give name and street address of the Registered Agent:
Name
Current Mailing Address
City State
Telephone Email
Current Physical Street Address
Zip City State Zip
The above information is true and correct to the best of my knowledge and belief and was provided by me
under oath (This form must be signed by the Financially Responsible Person if an individual or his attorney -
in -fact, or if not an individual, by an officer, director, partner, or registered agent with the authority to execute
instruments for the Financially Responsible Person). I agree to provide corrected information should there
be any change in the information provided herein.
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Type or print name
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Signature
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Title or Authority
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Date
I, ,i) k��% C , a Notary Public of the County of 4::�a 4&
State of , hereby certify that Cma�^v�-�
Personally accepted before me this day and under oath acknowledged that the above form was
executed by owner(s).
Witness my hand and notarial seal, this , day of 20 21
My Commission expires
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