NCC222849_FRO Submitted_20220810

%,sillitaiu, ki&-5) o�—��zno are unanciwy responsible for the� lar!6-disturbing..activi
comprehensive list of all responsible parti0s.on an atlnch6d sheet). ii t�a ��'O:
proptletorship, the name of the owner ormanagermaybe ijst6d.as�the�fi�� res
HEMBY BRIDGE VOLUNTEER FIRE
Name E-Mail Address
6628 MILL GROVE ROAD
Current Mailing Address
INDIAN TRAIL NC 28079
City State Zip

Telephone [phone] Fax Number
2. (a) If the Financially Responsible Party is not 8 resident of North
of the designated North Carolina Agent:
im
SMEM���
E-mailAddress
Current Street Address
9210MU-N-RUSESTME ME
0
Witness my hand and notarial seal, this _day Of PLAQU S�'., 20::-