NCC220879_FRO Submitted_20220301

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 N/A in the blank.)
Part A. Morrisville Fire Rescue Department Station #3
1. Project Name
2.
Location of land -disturbing activity: County Wake
City or Township Morrisville
Highway/Street 1021 Harris Mill Rd. Latitude 35.840848 Longitude-78.849218
3. Approximate date land -disturbing activity will commence: March 2022
4
5
6
7
8
Purpose of development (residential, commercial, industrial, institutional, etc.): institutional
Total acreage disturbed or uncovered (including off -site borrow and waste areas): 5 acres
Amount of fee enclosed: $ 325.00 . 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)
Has an erosion and sediment control plan been filed? Yes No Enclosed X
Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Eric Pearson E-mail Address [e-mail]
Telephone [phone] cell #
Fax #
9. Landowner(s) of Record (attach accompanied page to list additional owners):
Town of Morrisville
[phone]
Name
Telephone Fax Number
100 Town Hall Drive
(same as mailing address)
Current Mailing Address
Current Street Address
Morrisville, NC 27560
City State
Zip City State Zip
10. Deed Book No. 018198
Page No. 02090 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 orfirm is a sole proprietorship,
the name of the owner or manager may be listed as the financially responsible party.
Town of Morrisville
[e-mail]
Name
E-mail Address
100 Town Hall Drive
(same as mailing address)
Current Mailing Address
Current Street Address
Morrisville, NC 27560
City State
Zip City State Zip
Telephone [phone]
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:
Name
Current Mailing Address
City
Telephone
E-mail Address
Current Street Address
State Zip 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:
Name of Registered Agent
Current Mailing Address
E-mail Address
Current Street Address
City State Zip City State Zip
Telephone 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.
Type or print name Title or Authority
Signature Date
1, _ !C� �- W .. �Se"' 441 , a Notary Public of the County of Wa k e
State of North Carolina, hereby certify that Mar-Fha `_PC4 c To►-jr. rhua., e.- appeared
personally before me this day and being duly sworn acknowledged that the a Kve form was
executed by him.
Witness my hand and notarial seal, this i-1
day of 5e p 1-cin b 20 2. 1
L'). 5-y"-
Notary
My commission expires 12 4 1 2— 2 y

BK018198PGO2090
WAKE COUNTY, NC
CHARLES P. GILLIAM
REGISTER OF DEEDS
PRESENTED & RECORDED ON
11-20-2020 AT 12:16:02
STATE OF NC REAL ESTATE
EXCISE TAX: $4,100.00
BOOK: 018198 PAGE: 02090 - 02091
NORTH CAROLINA SPECIAL WARRANTY DEED
Excise Tax: $4,100.00
PIN: 0746.03-40-4889 Real Estate ID No.: 0367244
Return to: Jordan Price, 1951 Clark Avenue Raleigh North Carolina 27605
This instrument was prepared by: Barry D. Mann, Esq. of Manning. Fulton & Skinner P.A.
Brief description for the index: Lot 5 (6.33 acres), BM 2006-770
THIS DEED is made as of the 20' day of November, 2020, by and between:
GRANTOR
Town Hall Commons B2 LLC,
a North Carolina limited liability company
8320 Society Place
Raleigh, North Carolina 27615
GRANTEE
Town of Morrisville,
a municipal corporation
100 Town Hall Drive
Morrisville, North Carolina 27560
The designation Grantor and Grantee as used herein shall include said parties, their heirs,
successors, and assigns, and shall include singular, plural, masculine, feminine or neuter as
required by context.
WITNESSETH, that Grantor, for a valuable consideration paid by Grantee, the receipt of which is
hereby acknowledged, has and by these presents does grant; bargain, sell and convey unto Grantee
in fee simple that certain lot or parcel of land situated in the Town of Morrisville, Cedar Fork
Township, Wake County, North Carolina and more particularly described as follows:
Being all of Lot 5, containing approximately 6.33 acres, as shown on that
recombination and subdivision plat recorded in Book of Maps 2006, page 770, Wake
County Registry.
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3372008v 1.BDM.15843 324581

BKO18198PGO2091
The property hereinabove described was acquired by Grantor by instrument recorded in Book
13014, page 2306, Wake County Registry.
TO HAVE AND TO HOLD the aforesaid lot or parcel of land and all privileges and appurtenances
thereto belonging to Grantee in fee simple.
All or a portion of the property herein conveyed ❑ includes or ® does not include the primary
residence of Grantor.
And Grantor covenants with Grantee, that Grantor is seized of the premises in fee simple, has the
right to convey the same in fee simple, that title is marketable and free and clear of all
encumbrances, and that Grantor will warrant and defend the title against the lawful claims of all
persons by, through, or under Grantor, except for the exceptions hereinafter stated:
1. Ad valorem taxes for the year 2020 and subsequent years.
2. Enforceable easements, restrictions, and rights -of -way of record affecting title to the
Property.
IN WITNESS WHEREOF, Grantor has caused this instrument to be duly executed as of the day
and year first above written.
GRANTOR:
TOWN HALL COMMONS B2 LLC,
a North Carolina limited liability company
By: �Gt9a�
/,/� ,A
Stuart Edward White, Manager
STATE OF NORTH CAROLINA
COUNTY OF WAKE
I certify that the following person(s) personally appeared before me this day, each acknowledging
to me that he or she voluntarily signed the foregoing document for the purpose stated therein and
in the capacity indicated: Stuart Edward White .
Date: November l ` 2020 Notary Public:
Printed Name: ��(� Ae44J14
BARRY D. MANN
NOTARY PUBLIC My Commission Expires:
WAKE COUNTY, N.C.
My Commission Expires 03-17-2024.
3372008v1.BDM.15843324581