NCC231975_FRO Submitted_20230628

Check if this project is ARPA-funded ❑
Attach a copy of the Letter of Intent to Fund
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, including any
activity under a common plan of development of this size as covered by the NCGO1 permit, 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 address or phone
number is unavailable, place N/A in the blank.)
Part A.
l�
1. Project Name ! - trot ®(31 FOJr•25 ,_� CO✓K rug
++ \CM
*If this project involves American Rescue Plan Act(ARPA) funds, list the Project Name or Project
Number(e.g., SRP-D-ARP-0121) below under which you were approved for funding through the
Division of Water Infrastructure (DWI).
Cityor Townshipii ,, 11t 2. Location of land-disturbing activity: County �r � W 715-1-n
Highway/Street SU('( PnA -1)( TQI, Latltude(decimal degrees) LOngltUde(decimal degrees)
3. Approximate date land-disturbing activity will commence: (,((6/Z
4. Purpose of development(residential, commercial, industrial, institutional, etc.):
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas): , 3.3
It ov�
6. Amount of fee enclosed: $ i UI . The application fee of$100.00 per acre (rounded
up to the next acre) is assessed without a ceiling amount (Example: 8.10-acre application fee is $900).
Checks should be addressed to NCDEQ. /
7. Has an erosion and sediment control plan been filed? Yes�l Enclosed ❑ No ❑
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name E-mail7a-0 t SAC Address re,OLLZ 64(A -i✓1t,1/14S• C din'-)
Phone: Office# ' 651 21( Mobile# 336- 54(,' Z7,Gq
9. Landowner(s)of Record (attach accompanied page to list additional owners):
Name Phone: Office# Mobile#
%'1(( 1)11 34« (--k() (SAW
Current Mailidg Address Current Street ddress
56(9-vv, z703 cAL IOC Z703
City State Zip City State Zip
10. Deed Book No. /;l''° �7J Page No. Provide a copy of the most current deed.

Part B.
1. Company(ies)who are financially responsible for the land-disturbing activity(Provide a comprehensive list
of all responsible parties on accompanied page.) If the company is a sole proprietorship or if the landowner(s)is
an individual(s), the name(s) of the owner(s)may be listed as the financially responsible party(ies).
LLL
bdA, '
Company Name E-mail Addresq.
9-0
Current Mailingkddress Current Street Address
gAYEL § G Z71(8
City State Zip City State Zip
Phone: Office# �l 6 01 (( Mobile# 36 U
Note: If the Financially Responsible Party is not the owner of the land to be disturbed, include with this form
the landowner's signed and dated written consent for the applicant to submit a draft erosion and sedimentation
control plan and to conduct the anticipated land disturbing activity.
2. (a) If the Financially Responsible Party is a domestic company registered on the NC Secretary of State
business registry, give name and street address of the Registered Agent:
Name of Registered Agent E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office# Mobile#
Name of Individual to Contact(if Registered Agent is a company)
(b) If the Financially Responsible Party is not a resident of North Carolina, give name and street address
of the designated North Carolina agent who is registered on the NC Secretary of State business registry:
Name of Registered Agent E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office# Mobile#
Name of Individual to Contact(if Registered Agent is a company)

(c) If the Financially Responsible Party is engaging in business under an assumed name, give name under
which the company is Doing Business As. If the Financially Responsible Party is an individual, General
Partnership, or other company not registered and doing business under an assumed name, attach a copy
of the Certificate of Assumed Name.
Company DBA Name
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(s)
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 Party). I agree to provide
corrected information sho Id there be any change in the information provided herein.
OAin Gt+'ram Prcih
T e or print name Title or Authority
673
' nature Date
I, ,0"ts.4 a w\ `-nQ\VN\ , a Notary Public of the County of n (Ski\4-1(\
State of North Carolina, hereby certify that W n1 A-"Y\@ G, , -tl o f 0 appeared personally
before me this day and being duly sworn acknowledged that fhe above form was executed by him/her.
Witness my hand and notarial seal, thise) 6 day of —3 V•rk. 20 a 3
,``,``OAP„m,,,Cti '', �� A10,,4 V 1 '
l2. Notary
s tAR y Icy.:;
� 1=� My commission expires a
O A„
'Syr Or
'%, HCO

Book 3757 Page 3969
2023019131 00109
FORSYTH COUNTY NC FEE$26.00
PRESENTED&RECORDED
06/07/2023 01:27:57 PM
LYNNE JOHNSON
REGISTER OF DEEDS
BY: OLIVIA DOYLE,ASST
BK: RE 3757
PG:3969-3974
PREPARED BY and Return to:
Randall L. Perry
The Law Offices of Randall L. Perry, PLLC
1100 S. Stratford Road, Suite 325C
Winston-Salem,NC 27103
SUPPLEMENTAL DEED OF TRUST AND SECURITY AGREEMENT
This SUPPLEMENTAL DEED OF TRUST AND SECURITY AGREEMENT
("Supplemental Deed of Trust") is entered into as of the 6th day of June, 2023, by and between
TRUIST BANK, FORMERLY KNOWN AS BRANCH BANKING AND TRUST
COMPANY, A NORTH CAROLINA BANKING CORPORATION ("Lender"),
ISENHOUR HOMES, LLC, a North Carolina limited liability company ("Borrower"), and
BB&T COLLATERAL SERVICE CORPORATION ("Trustee"), with reference to the
following facts:
WITNESSETH:
WHEREAS, Lender previously agreed to extend to Borrower a loan that includes present
and future advances and/or future obligations in the original principal amount of Nine Million
Dollars ($9,000,000.00). In connection therewith, the Borrower executed and delivered for the
benefit of Lender that certain original Deed of Trust and Security Agreement dated October 11,
2017 and recorded in the Registry of Forsyth County,North Carolina in Book 3377 at Page 2052
("Master Deed of Trust") and modified by that Modification of Deed of Trust and Security
Agreement recorded in Book 3424 at Page 1304; and
WHEREAS, Lender desires the Borrower to execute this Supplemental Deed of Trust to
evidence their consent to the modifications to the Master Deed of Trust as hereinafter set forth;
NOW,THEREFORE,in consideration of Ten and No/100 Dollars ($10.00) in hand paid
by Lender to the Borrower, the receipt of which is hereby acknowledged, and of the mutual
covenants herein contained,the Borrower and the Lender agree as set forth hereinafter:
1
Submitted electronically by "The Law Offices of Randall L. Perry, PLLC"
in compliance with North Carolina statutes governing recordable documents
and the terms of the submitter agreement with the Forsyth County Register of Deeds.

Book 3757 Page 3970
1. Additional Property. To secure all indebtedness owed the Lender and referred to in the
Master Deed of Trust,the Borrower has given, granted,bargained, sold and conveyed, and
by these presents does give,grant,bargain, sell and convey unto the Lender,its successors,
and assigns the additional real property described on Exhibit "A" attached hereto (the
"Property"), together with all buildings, improvements, and fixtures, now owned by the
Grantor and located in or upon such real property, and in addition all other rights, titles,
privileges, powers and other items appurtenant to the aforesaid real property (hereinafter
called the "Collateral").
TO HAVE AND TO HOLD the Collateral and the Property, with all the rights,privileges,
and appurtenances thereunto belonging or appertaining to the Lender, its successors and
assigns, in fee simple forever, upon the trusts and for the uses and purposes set out in the
Master Deed of Trust;
And the Borrower covenants with the Lender that it is seized of the Collateral and Property
in fee and had the right to convey the same in fee simple; that title is marketable and free
and clear of all encumbrances; and that it will warrant and defend the title to the Property
and Collateral against the lawful claims of all persons whomsoever, except as to such
exceptions to title which are approved in a writing signed by the Lender prior to the
recording of this document.
2. General.
a. All references to the"Mortgage" or"Mortgage Instrument"in the Note or in any other
document given to secure the Note or any other obligations of the Borrower to the
Lender (collectively called the "Loan Documents") shall hereinafter be to the Master
Deed of Trust as modified hereby.
b. This Supplemental Deed of Trust shall bind and inure to the benefit of the successors
in interest hereto,and it is expressly understood and agreed that this Supplemental Deed
of Trust is a modification only and not a novation.
c. The Master Deed of Trust, as hereby modified, is incorporated in this Supplemental
Deed of Trust in its entirety by this reference, and all provisions of the Master Deed of
Trust shall be interpreted in accordance with and in light of the revisions and
modifications contained herein. The Borrower represents, affirnis and agrees that the
Master Deed of Trust,as modified hereby,along with all of the other Loan Documents,
are and shall remain in full force and effect and be binding upon Borrower without
defense or offset of any nature. Borrower, by its execution of this Supplemental Deed
of Trust, evidences its consent to the modifications hereinabove set forth.
d. It is expressly understood and agreed by the parties hereto that the agreements
contained in this Supplemental Deed of Trust shall in no way release,discharge,satisfy,
alter or impair the debt evidenced by the Note or any other obligations of any party to
the Lender or affect in any manner whatsoever the validity of the Note,the Master Deed
2

Book 3757 Page 3971
of Trust or the Loan Documents, or shall in any manner by construed to impair the
security of the Lender, and that the Note, the Master Deed of Trust, except as herein
modified, and the other Loan Documents shall each remain in full force and effect in
accordance with their respective terms and continue as evidence of the debt and security
for the payment of all money due or to become due thereon to Lender.
e. This Supplemental Deed of Trust may be executed in one of more counterparts, each
of which shall be deemed to be an original, but which shall constitute one and the same
instrument, and in making proof of the Supplemental Deed of Trust, it shall not be
necessary to produce or account for more than one such counterpart.
f. This Supplemental Deed of Trust shall be governed by and construed in accordance
with the laws of the State of North Carolina.
3. Additional Covenants Regarding Protection of Collateral Property.
a. In addition to all of the Lender's rights and remedies set forth in the Master Deed of
Trust and the Loan Documents, in the event of default by Borrower, or upon receipt of
any notification from any governmental or quasi-governmental authority regarding a
current,possible or pending violation of any applicable federal,state,county,municipal
and/or other governmental or quasi-governmental laws, rules, regulations, ordinances,
codes, requirements, covenants, conditions, orders, licenses, permits, approvals and
restrictions(the"Notice"), the Lender, and any persons authorized by the Lender, shall
have the right,but not the obligation,to enter upon the Property at any reasonable time
to repair, alter, replace, clean up or perforrn any necessary work or maintenance, in
Lender's discretion, in order to comply with the requirements of such Notice.
b. Borrower hereby agrees to indemnify and hold Lender harmless from and against any
and all damages, penalties, fines, claims, liens, suits, liabilities, costs (including,
without limitations, clean-up costs), judgments and expenses (including, without
limitation, attorneys', consultants', and experts' fees and expenses) of every kind and
nature suffered by or asserted against Lender as a direct or indirect result of any Notice
or legal requirements set forth in this section.Borrower's obligations under this section
will not be limited by the term of the obligations secured hereby, and, as to any act or
event occurring prior to payment in full and satisfaction of the obligations and all other
indebtedness and obligations under the Master Deed of Trust, Borrower's obligations
hereunder will continue, survive and remain in full force and effect notwithstanding
payment in full and satisfaction of the obligations and the Master Deed of Trust or
foreclosure under the Master Deed of Trust or delivery of a deed-in-lieu of foreclosure.
c. Nothing herein shall invalidate any security now held by Lender for the payment of the
obligations secured by the Master Deed of Trust, nor impair nor release any covenant,
condition, agreement or stipulation herein, and the same, as herein modified, shall
continue in full force and effect. Any collateral security held by Lender as security for
any of the obligations, including, without limiting the generality of the foregoing, any
rights acquired by Lender under any Security Agreement or Agreements, Assignment
3

Book 3757 Page 3972
of Rents, Financing Statements and other instruments shall stand as security for the
repayment of the obligations, and the Borrower covenants and agrees to confotiu with,
comply with, and abide by each and every of the terms, covenants, conditions,
agreements and stipulations of the obligations, including, but not limited to the Note
and the Master Deed of Trust, as may be modified, and all other security documents
evidencing or securing the obligations.
4. Additional Covenants.
The Borrower makes the representations, covenants, and agreements specified as follows:
a. Additional Representations and Warranties. The Borrower represents and
warrants to Lender as follows, and acknowledges that such representations and
warranties shall be continuing representations and warranties from Borrower to
Lender:
i. The Borrower is and shall remain in compliance with the Trading with
the Enemy Act, as amended, and each of the foreign assets control
regulations of the United States Treasury Department(31 CFR, Subtitle
B, Chapter V, as amended) and any other enabling legislation,
regulations or executive orders relating thereto, and the Uniting and
Strengthening America By Providing Appropriate Tools Required To
Intercept and Obstruct Terrorism Act (USA Patriot Act of 2001), as
amended, and any other enabling legislation, regulations or executive
orders relating thereto;
ii. The Borrower is and shall remain in compliance with 31 U.S.C., Section
5313, as amended, 31 C.F.R. Section 103.22, as amended, and any
similar laws or regulations involving currency transaction reports or
disclosures relating to transactions in currency of more than$10,000.00,
or of more than any other minimum amount specified by any laws or
regulations; and
iii. The Borrower (i) is not a person whose property or interest in property
is blocked or subject to blocking pursuant to Section 1 of Executive
Order 13224 of September 23,2001 Blocking Property and Prohibiting
Transactions With Persons Who Commit, Threaten to Commit, or
Support Terrorism (66 Fed. Reg. 49079 (2001)), (ii) does not engage in
any dealings or transactions prohibited by Section 2 of such executive
order, and is not otherwise associated with any such person in any
manner violative of Section 2, or (iii) is not a person on the list of
Specially Designated Nationals and Blocked Persons or subject to the
limitations or prohibitions under any other U.S. Department of
Treasury's Office of Foreign Assets Control regulation or executive
order.
4

Book 3757 Page 3973
b. Additional Covenants, The Borrower covenants and agrees with Lender that no part
of any loan proceeds or advances evidenced by or referenced in this Deed of Trust, and
no part of any other amounts or sums derived from any property which secures
repayment of such loan proceeds or advances, including, without limitation, any
accounts,payment intangibles, money,rents, issues or profits, will be used, directly or
indirectly, for any payments to any governmental official or employee,political party,
official of a political party, candidate for political office, or anyone else acting in an
official capacity, in order to obtain, retain or direct business or obtain any improper
advantage, in violation of the United States Foreign Corrupt Practices Act of 1977, as
amended.
IN WITNESS WHEREOF,the Borrower has caused this Supplemental Deed of Trust to
be executed in its name, under seal, all by authority duly given, as of the date herein first above
written.
BORROWER:
ISENHOUR HOMES,LLC, a North Carolina limited liability company
,j \
By: 1 (SEAL)
BILL WALTER
Manager
THE STATE OF NORTH CAROLINA
COUNTY OF FORSYTH
I, Randall L. Perry, a Notary Public for the County and State aforesaid, do hereby certify
that the foregoing instrument was voluntarily executed for the purposes therein stated by Bill
Walter, Manager of ISENHOUR HOMES, LLC, a North Carolina limited liability company, and
that he/she, as Manager, being authorized to do so, executed the foregoing on behalf of the
corporation for the purposes stated herein and in the capacity indicated.
Witness my hand and official seal this 6th day of June, 2023.
RANDALL L. PERRY
Notary Public, North Carolina By:
Forsyth county Ran all L. Perry,Notary Public
My Commission Expires
July 02,2026
My Commission Expires: 7-2-2026
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Book 3757 Page 3974
EXHIBIT "A"
BEING KNOWN AND DESIGNATED as Lots 49 and 50 as shown on the Plat
entitled "Sherwood Forest Section 19, Phase 1," which plat is recorded in Plat
Book 77, Page 79, in the Office of the Register of Deeds of Forsyth County, North
Carolina, reference to which is hereby made for a more particular description.
6