NCC216990_FRO Submitted_20211217

FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL. ACT
No person may initiate any land -disturbing activity on one or more acres as covered by the Act before this
form and an acceptable erosion and sedimentation control plan have been completed and approved by
the Land Quality Section, N.C. Department of Environmental Quality. Submit the completed form to the
appropriate Regional Office. (Please type or print and, if the question is not applicable or the e-mail and/
or fax information unavailable, place NIA in the blank.)
Part A. 1. Project NameTopsail Sound RV Park
2. Location of land -disturbing activity: County Onslow City or Township Holly Ridge
Highway/Street 743 Morris Landing Road Latitude 3428'30.63"N Longitude 7730'57.32"W
I Approximate date land -disturbing activity will commence: Fal l 2021
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Commercial
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 14 acres
6. Amount of fee enclosed: $ 91 0 . The application fee of $65.00 per acre (rounded
up to the next acre) is assessed without a ceiling amount (Example: a 9-acre application fee is $585).
7. Has an erosion and sediment control plan been filed? Yes No Enclosed X
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name -George Gudgeon E-mail Address george_gudgeonCaequitylifestyle.com
Telephone [phone] cell # (312)-405-7510 Fax #
9. Landowner(s) of Record {attach accompanied page to list additional owners):
M HC TOPSAIL RV, L.P. [phone]
Name Telephone Fax Number
2 N. Riverside Plaza 2 N. Riverside Plaza
Current Mailing Address Current Street Address
Chicago, IL 60606 Chicago, IL 60606
City State Zip City State Zip
10. Deed Book No. 5352 Page No. 271 Provide a copy of the most current deed.
Part B.
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.
MHC TOPSAIL RV, L.P. [e-mail]
Name
Two N. Riverside Plaza
Current Mailing Address
Chicago, IL 60606
City State Zip
Telephone [phone]
E-mail Address
Two N. Riverside Plaza
Current Street Address
Chicago, IL 60606
City State Zip
Fax Number

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:
Ivia Austin
Name
192 Thousand Trails Drive
Current Mailing Address
Advance, NC 27006
City
State Zip
Telephone [phone]
sylvia_austin@)equitylifestyle.com
E-mail Address
192 Thousand Trails Drive
Current Street Address
Advance, NC 27006
City State Zip
Fax Number
(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:
CT Corporation System
Name of Registered Agent
150 Fayettevi Ile Street # 1011
Current Mailing Address
Raleigh, NC 27601
City State Zip
Telephone [phone]
E-mail Address
150 Fayetteville Street #1011
Current Street Address
Raleigh, NC 27601
City State Zip
Fax Number
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.
George Gudgeon
T ria
Signature
--------------------------------------------------------------
Senior Vice President
Title or Authority
1126Z_
Date
:�a Notary Public of the County of
State of Imo, hereby certify hat & eo CA SZ C v(-)appeared
personally before me this day and being duly sworii acknowledg6d that the above form was
executed by him.
Witness my hand and notarial seal, this_2::_�day of ? �ti s , 20L_
OFFICIAL SEAL Notar
DA\%UICKEY
NOTARY PUBLIC - STATE OF ILLINOIS My commission expires L`' ^7 ` I Q -- 2G 2 If
MY COMMISSION EKPIRES:47114/24