NCC224040_FRO Submitted_20221207

FINANCIAL RESPONSIBILITY OWNERSHIP (FRO) FORM
Soil Erosion and Sedimentation Control Ordinance
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vCORTii CAROLINA
Instructions: No person shall initiate any land -disturbing activity on one or more acres, as covered in the Town of
Huntersville Soil Erosion and Sedimentation Control Ordinance, before this form and an acceptable erosion and
sedimentation control plan have been completed and approved by the Town of Huntersville. The Financially
Responsible Party will be on record as the party to accept any Notices of Violation or related documents for any non-
compliance of the Town of Huntersville Soil Erosion and Sedimentation Control Ordinance. If the Financially
Responsible Party resides out of state, a North Carolina agent must be assigned. All relevant items on this form
must be filled out accurately and completely.
PART A - Complete All Fillable Fields
1. Project name Gilead Rd. Mixed Use
2. Address of land -disturbing activity (number, street) 202-208 Gilead Road
3. Approximate date land -disturbing activity will begin Mixed Use SCj<on5r tta ILb�yter a date.
4. Purpose of development Choose an item. Other:
5. Total acreage of land to be disturbed or uncovered 3.83 AC
6. Total site acreage 3.91
7. Landowner (s) of Record. Names listed must match the deed(s). Attach list of additional owners, if applicable.
Note: If the landowner of record is not the person(s) or ftrm(s) Financially Responsible Party, as listed in Part
B, item 1, a separate letter of consent, signed and dated by the landowner of record, or their authorized agent,
is required
Name
HFH Partners, LLC
Mailing
Address
121 Gilead Rd
Contact Name
Jay Henson
City: Huntersville
Title
Member
State: NC Zip: 28078
Phone: Office/Main
704-577-4561
Street
Address
If PO Box listed above
Phone: Mobile
same
City:
Email
State: Zip:
Name
Mailing
Address
Contact Name
City:
Title
State: Zip:
Phone: Office/Main
Street
Address
if PO Box listed above
Phone: Mobile
City:
Email
State: Zip:
8. Indicate Book and Page number where the deed or instrument is filed Attach list ofaddt'1 deeds ijapplicable
Deed Book37447
Deed Book 35707
Page 63
Page 745
Deed Book 37447
Deed Book 35048
Page 47
Page 268
Rev. 6/2022 TOH Staff Reviewer Ownership/Agent: Verified at Pre -Con Meeting By: Pagel of 2

FINANCIAL RESPONSIBILITY OWNERSHIP (FRO) FORM
Soil Erosion and Sedimentation Control Ordinance
PART B — Sections 1, 2 and 4 are required
jl*:Mre f
NORTH CAROLINA
Person(s) or firm(s) who are financially responsible for this land -disturbing activity. Note: If the Financially
Responsible Person(s) or Firm(s) has an out-of-state address, a North Carolina agent must be designated in
item 2, below.
Person or Firm
HFH Partners, LLC
If Company or Firm, list name as listed on NC Secretary o State business registry
Mailing Address
City: State: Zip:
Street Address
City: State: Zip:
121 Gilead Rd. Huntersville, NC 28078
Required ifPO Box listed as Mailing Address
Contact Name
Uay Henson
Email
Phone: Office
704-577-4561
Phone: Mobile
704-577-4561
2. If the Hnancially Responsible Party is not a resident of North Carolina, provide the information of the
designated North Carolina agent who is registered on the NC Secretary of State business registry.
Registered Agent Name Name as listed on NC Secretary of State business registry
Mailing Address
City: State: Zip:
Street Address
City: State: Zip:
1 PO Box listed above
Email
Phone
3. (Optional) Additional contact familiar with the site, understands the plans, and may represent the company.
Site Contact's Name Jay Henson
Email [e-mail]
Phone: Office 704-577-4561 Phone: Mobile [phone]
4. 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. If
the Financially Responsible Owner is not an individual, this form must be signed by an officer, director, partner, or
registered agent with the authority to execute instruments for the Financially Responsible Party). I agree to provide
corrected information should there by any change in the information provided herein.
Printed Name
Wet -Ink Signature
Title or Authority Member
Date
1, Ss , a Notary Public of the County of L� J f7Cy r/7 ,State
ofllfy rn L, hereby certify That n personally appeared
before me worn acknowledged that thve orin was executed b
this day and being duly e o
s .>r y hit tt/her.
Witness my hand and notarial seal, this day of L I W, 20J;;�
Notary Signature
4. NOTARY PU1UQ NpRTri cA NA
�K�W E
PHENS My Commission xpires
t
Rev. 6/2022
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