NCC231874_FRO Submitted_20230621

Town of Cary
f4,s„ Stormwater Division
316 N.Academy St.
Cary,NC 27513
FINANCIAL RESPONSIBILITY-OWNERSHIP FORM
No person may initiate any land-disturbing activity covered by the Town of Cary Sedimentation and
Erosion Control Ordinance before completing and filing this form with the Town of Cary Stormwater
Division. Indicate N/A if a question is not applicable.
PROJECT NAME Lincoln Harris "The Press"
PROJECT DEVELOPMENT PLAN# 22 DP-10333
PROJECT LOCATION 2001 Evans Rd
APPROXIMATE DATE OF PROJECT INITIATION 4/17/2023
ACREAGE OF LAND TO BE DISTURBED 0.99
PERSON(S)OR FIRM(S) FINANCIALLY RESPONSIBLE FOR THIS LAND-DISTURBING ACTIVITY:
(If out of state,a registered agent in North Carolina must be used.)
Copper III, 2021 LLC
Name(Person or Firm)
301 Commerce Street, Suite 3300
Street Address(No PO Box)
Fort Worth, Texas 76102
City State Zip
919-215-4872
Telephone Number
Fax Number
[e-mail]
E-Mail Address
REGISTERED AGENT FOR THE PERSON OR FIRM WHO IS FINANCIALLY RESPONSIBLE:
David Connor
Name
5400 Trinity Rd, #200
Street Address(No PO Box)
Raleigh, NC 27607
City State Zip
Town of Cary
316 North Academy Street,Cary,NC 27513 PO Box 8005,Cary,NC 27512-8005
Tel[phone] www.townofcary.org
Form updated 02/17/2022

919-215-4872
Telephone Number
Fax Number
[e-mail]
E-Mail Address
The Town reserves the right to contact either the financially responsible person or registered agent listed
below in case of violation. Please indicate your preference below.
oR David Connor
Financially Responsible Person Registered Agent
THE ABOVE INFORMATION is true and correct to the best of my knowledge and belief and as provided
by me while under oath. (This form must be signed by the financially responsible person if an individual or
by an officer, director, partner, attorney-in-fact, or other person with authority to execute instruments for
the financially responsible person if not an individual.)
David Connor
or Print Name
Signature
Senior Vice President
Title or Authority
Date
North Carolina
Wake County
I, 114VL C.. i'�ERQON) , a Notary Public of the County of \iikk& , North
Carolina, do hereby certify that 1PNS40 CONNOR_ personally appeared before me this day
and under oath acknowledged that the above form was executed by him/her.Witness my hand and
notarial seal,this 3 day of 1}PkLL , 2423 .
PAUL C.NOTARYRON
PUBLIC
Notary Public
My commission expires O11 eth-Ot-1. Wake county
North Carolina
My Commission!-wires Oi/121 tot4
Town of Cary
316 North Academy Street,Cary,NC 27513 PO Box 8005,Cary,NC 27512-8005
Tel[phone] www.townofcarv.org
Form updated 02/17/2022
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