NCC222385_FRO Submitted_20220630

WAKE COUNTY 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 Wake
WAKE County Unified Development Ordinance before this form and an acceptable erosion and
COUNTY sedimentation control plan have been completed and approved by Wake County Department of
Environmental Services, Water Quality Division. (Please type or print and, if the question is not
applicable, place N/A in the blank.)
Part A. f
1. Project Name Yo17k-s /J'1(
2. Location of land -disturbing activity: Jurisdiction (Oa 4c- Co • (Wake Co. or Municipality)
Highway/Street a317 l aall MJI C;6 • Latitude 3S-•• `7/;XO3 Longitude %3 0 `I q
3. Approximate date land -disturbing activity will commence:
4. Type of development (residential, commercial, industrial, institutional, etc.): /L S :d_l„.. - u.Q.-
5. Total acreage disturbed or uncovered (including off -site utilities and borrow/waste
areas): 0•5785
6. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name 6t)-t.3 E-mail Address N-u 0-) (U�/K��bcc
Telephone q - ,4 V -1/a.9"1 Cell # 'T/ �- 90 / - 17S) y Fax #
7. Landowner(s) of Record (attach accompanied page to list additional owners):
Goy -1 &tsa,& k t*a 11-41,
Name(s)
Current Mailing Address
Ca,+ lU C -66;�3
City State Zip
Telephone
Fax or E-mail address
3C10 0__
Current Street Address
sam.A-
City State Zip
8. Deed Book No. O 17(Y Page No. 0/ 9a11 Provide a copy of the most current deed.
Part B.
Person(s) or firm(s) who are financially responsible for the land -disturbing activity (Provide a
comprehensive list of all responsible parties on an attached sheet. Include requested information):
/NC.
Name
/l / Corn ffW'VW ".l,l-l.
Current Mailing Address
City IState Zip
Telephone q19 - 23 y - Al,_e i
IA)-'-) a tocL/K,Ir 4b61,d
E-mail Address
Current Street Address
,S a,N-e-
City State Zip
Fax Number R/ 1 - A3 y - A%29 S

Home Wake County Real Estate Data
Real Estate ID 0478025
WAKILocation Address
COUNTY
2317 TOLL MILL CT
:Y�, I i .>:R 0.
Ownership History
PIN # 0781059095
Property Description
L058 SANCTUARY AT YATES MILL PH2 BM2020-01401
Pin/Parcel History Search Results New Search
iMaps
Tax Bills
Account
Search
Disclaimer: The information on this site, including but not limited to the real estate "Owner Name" and date of acquisition, is provided for
informational purpose only and is gathered from public records submitted, filed and recorded with various government departments, agencies,
and offices. Although every effort has been made to ensure that the information presented on this website is accurate and timely, it is not
intended to replace information that could be obtained directly from any other government department, agency, or office, nor should it be used
as the exclusive basis for determining ownership or date of acquisition of real property. Wake County makes no representation or warranties,
express or implied, concerning the accuracy, completeness, reliability, or suitability of the information provided herein or the status of title to
the subject real estate.
"Wake County assessed building and land values reflect the market value as of January 1, 2020, which is the date of the last
county -wide revaluation. Any inflation, deflation or other economic changes occurring after this date does not affect the
assessed value of the property and cannot be lawfully considered when reviewing the value for adjustment.
The January 1, 2020 values will remain in effect until the next county -wide revaluation. Until that time, any real estate
accounts created or new construction built is assessed according to the 2020 Schedule of Values.
For questions regarding the information displayed on this site, please contact the Department of Tax Administration
at [e-mail] or call 919-856-5400.

IliaHome Wake County Real Estate Data iMaps
Account Summary Tax Bills
'Real Estate ID 0478025 PIN # 0781059095 Account
Search
WAULocation Address Property Description
COUNTY 2317 TOLL MILL CT LO58 SANCTUARY AT YATES MILL PH2 BM2020-01401
Pin/Parcel History. Search Results New Search
Property Owner ; owner's Mailing Address ; Property Location Address
BATALLER, GARY & SUSAN 232 HANOVER PL 12317 TOLL MILL CT
(Use the Deeds link to view any additional owners); CARY NC 27511-6623 RALEIGH NC 27606-8989
Administrative Data
?
Transfer Information
Assessed Value
Old Map #
677-- i
Map/Scale
0781 01
Deed Date
12/8/2021
Land Value Assessed $180,000
VCS
18WC171
Book & Page
18832 1116 !
Bldg. Value Assessed
City
Revenue Stamps
380.00
Fire District
23
Pkg Sale Date
Township
SWIFT CREEK !
Pkg Sale Price
Tax Relief
Land Class
VACANT
Land Sale Date
12/8/2021
ETJ
WC l
Land Sale Price
$190,000
Land Use Value
Spec Dist(s)
Use Value Deferment
Zoning
R-40W ;Improvement
Summary
;
Historic Deferment
History ID 1
j
Total Deferred Value
History ID 2
?
Total Units
0
Acreage
•69
Recycle Units
0 j
Permit Date
'
Apt/SC Sqft
;Use/Hist/Tax
Relief
Permit #
Heated Area
Assessed
1
Total Value Assessed* $180,000
*Wake County assessed building and land values reflect the market value as of January 1, 2020, which is the date of the last
county -wide revaluation. Any inflation, deflation or other economic changes occurring after this date does not affect the
assessed value of the property and cannot be lawfully considered when reviewing the value for adjustment.
The January 1, 2020 values will remain in effect until the next county -wide revaluation. Until that time, any real estate
accounts created or new construction built is assessed according to the 2020 Schedule of Values.
For questions regarding the information displayed on this site, please contact the Department of Tax Administration
at [e-mail] or call 919-856-5400.

2. (a) If the Financially Responsible Party is not a resident of Wake County, identify a designated agent in
Wake County to receive any notice, process, pleading in any action or legal proceeding arising out of any
matter relating to the Wake County Erosion and Sedimentation Control Ordinance and/or Land
Disturbance Permit:
Name
Current Mailing Address
City State Zip
Telephone
E-mail Address
Current Street Address
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:
I
Name of Registered Agent E-mail Address
/// iuinmc,',Wta1P1 t2t• Sf-e. /0
Current Mailing Address
Ca-,L Al C 1-4175' it
City UState Zip
Telephone q I y - �,3 q - lAyq
Sam
Current Street Address
Sa ne
City State Zip
Fax Number 114- a�3 q -
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 rint name Title or Authority
Sig ature Date
I, -,a Notary Public of the County of (,t/ a i1--c.
State of North Carolina, hereby certify that Uja bc'r appeared
personally before me this day and being duly sworn acknowledged that the above form was executed by him.
Witness my hand and notarial seal, this ` , d day of 20
1IIII/It/
Gut
ii
Seal _= %0TNK .
Notary
PUidt�C _ My commission expires q-
F/COUNl \\��
Ao,gy

WAKE COUNTY, MC 313
LAURA M RIDDICK
REGISTER OF DEEDS
PRESENTED 8 RECORDED ON
08�25l2810 AT 14:49:38
BOOK:814048 PAGE:89199 - 00200
CORPORATE CERTIFICATE OF ASSUMED NAME
The undersigned corporation, proposing to engage in business in k/A{Cc County,
North Carolina, under an assumed name other than its corporate name, hereby certifies that:
f. The name
d� ��under which the business iss to be conducted is:
y�AL4_-'It 06y(51l,urc-to
(Insert assumed name)
2. The names and address of the owner(s) of the business is (are):
ttRANp'LWH G. �,IALwerc } InJ�sLEY R• !�/.4�rcF,c
� � � ��.i-y.✓wEi4c_TK GTE �c�r i E /t� 1`
(:-/4
(Insert name and address of corporation)
In witness whereof, this certificate is signed in the name of the corporation by Its president
and secretary,this o2f- dayof 1AvCcrr .20 /o
Affix Corporate Seal By:
President
By: 4<—s /-- C�-
Secretary
State of /VJr-0-A C,drWU�v,4
County of l✓-XF
I, RUC 1n&L x a Notary Public, do hereby certify that
RAA10e c.r"N and r. personally appeared before me
this 2 r " day of Au(;,,tT- 20 /0 • and that they signed the foregoing certificate on
behalf of the said corporation in the respective capacities Indicated.
Witness my hand and official seal, this the 2F A< day of A"CyJr .20/6
Notary Public
My Commission Expires: {A - 5
,01;0 0 )
3d�UVI
c
Mailing Address: Wake County Register of Deeds, P. O. Box
NC 27602