NCC232526_FRO Submitted_20230822

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.
1. Project Name Walgreens # 17623
*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).
2. Location of land-disturbing activity: CountyGUllford City or Township Greensboro
Randleman Rd. 36.0367 -79.8005
Highway/Street Latitude(decimal degrees) Longitude(decimal degrees)
3. Approximate date land-disturbing activity will commence:8/21/23
4. Purpose of development(residential, commercial, industrial, institutional, etc.): commerical
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas): 1 .07
6. Amount of fee enclosed: $200.00 . 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 El Enclosed El No ❑
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
E-mail Address
Name Patrick [e-mail]
Phone: Office# 804-368-6010 Mobile# [phone]
9. Landowner(s) of Record (attach accompanied page to list additional owners):
HRP Investements, Inc. 954-647-4261
Name Phone: Office# Mobile#
PO Box 1519 34 Lata Palm Ct.
Current Mailing Address Current Street Address
Cashiers, NC 28717 Blythewood, SC 29016
City State Zip City State Zip
10. Deed Book No.8738 Page No.255-259 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).
HRP Greensboro, Inc. [e-mail]
Company Name E-mail Address
34 Lata Palm Ct.
Current Mailing Address Current Street Address
Blythewood, SC 29016
City State Zip City State Zip
Phone: Office# Mobile#[phone]
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:
Peel and James PLLC [e-mail]
Name of Registered Agent E-mail Address
106 S. Smithwick St.
Current Mailing Address Current Street Address
Williamston, NC 27892
City State Zip City State Zip
Phone: Office# 252.792.31 15 Mobile#
Nathan James
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 should there be any change in the information provided herein.
Brian Hunt Executive Vice President
Type or ' am Title or Authority
August 21, 2023
Sig ure Date
S'ele-41p PGt 1 , a Notary Public of the County of Piaia--,�
State of North Carolina, hereby certify that PrI "'" appeared personally
before me this day and being duly sworn acknowledged that the above form was executed by him/her.
Witness my hand and notarial seal, this 1 day of ' *"..5 , 20 a3
11/j 1 )0,0 00,111 PA.
��. Notary
My commission expires
PUBL\�'�'Z�
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Continued from Items 9 & 10 in Part A of the Financial Responsibility/Ownership Form for multiple
owners. Attach copies of this page as needed to list all landowners.
Landowner 2 of Record:
Name Phone: Office# Mobile#
Current Mailing Address Current Street Address
City State Zip City State Zip
Deed Book No. Page No. Provide a copy of the most current deed.
Landowner 3 of Record:
Name Phone: Office# Mobile#
Current Mailing Address Current Street Address
City State Zip City State Zip
Deed Book No. Page No. Provide a copy of the most current deed.
Landowner 4 of Record:
Name Phone: Office# Mobile#
Current Mailing Address Current Street Address
City State Zip City State Zip
Deed Book No. Page No. Provide a copy of the most current deed.
Landowner 5 of Record:
Name Phone: Office# Mobile#
Current Mailing Address Current Street Address
City State Zip City State Zip
Deed Book No. Page No. Provide a copy of the most current deed.

Continued from Item 9 in Part B of the Financial Responsibility/Ownership Form for multiple parties.
Attach copies of this page as needed to list all financially responsible parties.
Company 2 Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office# Mobile#
Company 3 Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office# Mobile#
Company 4 Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office# Mobile#
Company 5 Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office# Mobile#

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BK: R 8738
PG: 255-259 NC FEE$26.00
RECORDED: 2023027574 STATE OF NC
06/20/2023 GUILFORD COUNTY, NC REAL ESTATE
02:49:12 PM JEFF L.THIGPEN
EXTX$860.00
DEPUTY-GB REGISTER OF DEEDS
BY:MARY BROWN
This instrument prepared by Nathan A. James a licensed North Carolina attorney. Delinquent
taxes, if any,to be paid by the closing attorney to the county tax collector upon disbursement of
closing proceeds.
PREPARED BY NATHAN A. JAMES
PEEL AND JAMES
ATTORNEYS AT LAW
Parcel ID: 29738,29740 and 29742 107 UNION DRIVE, SUITE 201
Excise Tax: $860.00 WASHINGTON,N.C. 27889
WARRANTY DEED
NORTH CAROLINA
GUILFORD COUNTY {{
THIS DEED,made this the (14h day of June, 2023 by,Dees Real Estate Holdings LLC,
a North Carolina Limited Liability Company with its registered office address of 3905 Katie
Drive Greensboro,NC 27410, GRANTOR, to,HRP Investments, Inc., a Florida Corporation
with a principal office address of 291 SW 75 Terrace, Plantation,FL 33317,parties of the second
part, GRANTEES.
WITNESSETH:
The said party of the first part, in consideration of the sum of Ten($10.00) DOLLARS
and other good and valuable considerations to them paid by the parties of the second part, the
receipt of which is hereby acknowledged,have bargained and sold, and by these presents do
grant, bargain, sell and convey to said parties of the second part, their heirs, successors,
submitted electronically by "Peel and James, PLLC"
in compliance with North Carolina statutes governing recordable documents
and the terms of the submitter agreement with the Guilford county Register of Deeds.

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administrators,and assigns,that certain tract or parcel of land in Guilford County, State of North
Carolina,and more particularly described as follows:
SEE EXHIBIT"A"ATTACHED
The described property is not the primary residence of the Grantor.
TO HAVE AND TO HOLD the same,together with all and singular the rights,ways,
privileges and appurtenances thereto belonging or in anywise appertaining unto the said
Grantees,their heirs and assigns,in fee simple, subject to the following:
1. 2023 and subsequent Guilford County ad valorem taxes.
2. Non-compliance with any local,county, state or federal governmental laws,
ordinances or regulations relative to zoning, subdivision,occupancy,use,
construction or development of the subject property.
3. Matters shown on Plat Book 73 at Page 285,Guilford County Registry
And the said party of the first part covenants to and with the said parties of the second
part that it is seized of the said premises in fee and has a legal right to convey the same in fee;
that the same are free and clear of all encumbrances and that it does hereby forever warrant and
will forever defend the said title to the same against the claims of all persons whomsoever.
IN TESTIMONY WHEREOF,the said party Dees Real Estate Holdings LLC has caused
this Deed to be executed in its name by its duty authorized Member/Manager and has adopted as
its seal the word"SEAL"appearing beside its name, this sealed instrument being executed and
delivered on the day and year first above written.

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Dees R Estate Holdings (LLC
Z. (J1.-• (SEAL)
y George . Dees, Member/Manager
STATE OF N Oe l N- N A--
COUNTY OF` , `- Cl
I, aL -k-- ,a Notary Public in and for the aforesaid County
and State,do hereby certify that George R.Dees,personally appeared before me this day and
acknowledged that she is the manager of Dees Real Estate Holdings LLC, a limited liability
company, and further acknowledged the due execution of the foregoing Deed on behalf of the
limited liability company.
Witness my hand and official seal this leg day of June,2023.
/P-1 •
Notary Publ'
My Commission Expires: 07/2,026
00 ""u,
(PLEAWi yY SEAL HERE)
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Dees Real Estate Holdings LLC
_ c r L DAS (SEAL)
By(anet L. Dees,Member/Manager
STATE OF 140,0 Yl(l1f
COUNTY OF (i 1- DY Gl _
I, M J YI ( 1 N . > ,a Notary Public in and for the aforesaid County
and State,do hereby certify that Janet L.Dees,personally appeared before me this day and
acknowledged that she is the manager of Dees Real Estate Holdings LLC,a limited liability
company,and further acknowledged the due execution of the foregoing Deed on behalf of the
limited liability company.
Witness my hand and official seal this ,t) day of June,2023.
Notary ;D rr` N �
My Commission.Expires:
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(PLEASE PLACE NOTARY SEAL HERE)
Meghan N.Alberty
NOTARY PUBLIC
Guilford County
North Carolina
My Ccomiesion EVires MOW 19.2028

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Exhibit"A"
All of Lots I, 3 and 4 as shown on the plat entitled"Property of Julius Dees, Jr."which appears
of record in the Office of the Register of Deeds of Guilford County,North Carolina, in Plat Book
73, Page 285.