NCC232984_FRO Submitted_20231006

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 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 a-mall and/
or fax information unavailable, place N/A in the blank.)
Part A. One Place-Jacksonville
1. Project Name
2. Location of land-disturbing activity: County Onsiow City or Township Jacksonville
Highway/Street Commons Place Drive N Latitude 34.4741 Longitude -77.247
3. Approximate date land-disturbing activity will commence: October 5,2023
4, Purpose of development(residential,commercial, Industrial, institutional,etc.): Inslitullonal
5. Total acreage disturbed or uncovered(including off-site borrow and waste areas): 4.80
N/A 6. Amount of fee enclosed: $ N/A . The application fee of$100.00 per acre
(rounded up to the next acre)Is assessed without a ceiling amount(Example:8.10 ac=$900,00).
7. Has an erosion and sediment control plan been filed? Yes 4.80 No Enclosed
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Stephen Nunn E-mail Address snunn®mckinieybuilding,com
Telephone [phone] Cell# 910-523-0855 Fax# [phone]
9. Landowner(s)of Record(attach accompanied page to list additional owners):
One Place(do Dawn Rochelle) 910-938-0336 NA
Name Telephone Fax Number
900 Dennis Road 900 Dennis Road
Current Mailing Address Current Street Address
Jacksonville NC 28546 Jacksonville NC 28546
City State Zip City State Zip
10. Deed gook No. 5742 Page No. 616 Provide a copy of the most current deed.
Part B.
1. Company(les) or firms) who are financially responsible for the land-disturbing activity (Provide a
comprehensive list of all responsible parties on an attached sheet.)if the company or firm Is a sole proprietorship,
the name of the owner or manager may be listed as the financially responsible party,
One Place(cto Dawn Rochelle) Dawn.RochelleQoneplaceonslow,org
Name E-mail Address
900 Dennis Road
900 Dennis Road
Current Mailing Address Current Street Address
Jacksonville NC 28546 Jacksonville NC 28546
City State Zip City State Zip
Telephone [phone] Fax Number NA

2. (a) If the Financially Responsible Party Is not a resident of North Carolina, give name and street address
of the designated North Carolina Agent:
Name e,mN I\,Address
\\\ •
Current Mailing Address \ •urrent Street Address
City \St to \ jjl City State Zip
J
Telephone -�\> Fax Number
(b) If the Financially Responsible;Party is a Partnership or other person engaging in business under an
assumed name, attach a copy of the Certificate of Assumed Name. If the Financially Responsible
Party is a Corporation, 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
Telephone Fax Number
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, or if not an individual, by an officer, director, partner, or registered agent with
the authority to execute instruments for the Financially Responsible Person). I agree to provide
corrected information should there be any change In the information provided herein.
Dawn Rochelle Chief Executive Officer
,_Type or print-na e r Title or Authority
( 1 Q,--`l KC) 'O L`C��(. D i1 <�,bd J r a
Signature Date
I, La\ L__,\A/6Y-o'1 _, Notary Public of the Countyof Un
State of North Carolina, hereby certifythat � ,(� n )(
J t� � �1. �In c_,1 le appeared
personally before me this day and being duly sworn acknowledged that the above form was
executed by him.Witness my hand and notarial seal, this ,r(day of (1�J`r�
-1D f}br--- , 20 2 ,a
1-� i)nrk . \atr(
• Not ry ��
LaWanna Wooden ��
NOTARY PUBLIC My commission expires
Onslow County, NC
My Commission Expires April 03,2027

Type: CONSOLIDATED REAL PROPERTY
Recorded: 5/2/2022 12:46:23 PM
Fee Amt: $26.00 Page 1 of 5
Revenue Tax: $0.00
Onslow County, NC
Omega K. Jarman Reg. of Deeds
BK5742 PG616 - 620
NO TITLE EXAM REQUESTED
Prepared by: John T. Carter, Jr. , Jacksonville City Attorney
Parcel ID No. : 059876
Mail to:
The hereinafter described property is not the primary residence of Grantor.
SPECIAL WARRANTY DEED
Excise tax: WMX
Exempt NCGS S&;c. 105.228.28
NORTH CAROLINA
ONSLOW COUNTY:
THIS DEED, made this 2_> ' czay ofnv; I , 2022 by and
between the City of Jacksonville a North Carolina municipal
corporation with an office located in Jacksonville, North
Carolina, hereinafter referred to as Grantor, and One Place, a
North Carolina non-profit corporation**of Onslow County, North
** whose mailing address is 900 Dennis Road, Jacksonville, NC 28546
Carolina, hereinafter referred to as Grantee;
WITNESSET H:
That the Grantor, for a valuable consideration paid by the
Grantee, the receipt of which is hereby acknowledged, has and by
these presents does grant, bargain, sell and convey unto the
Grantee, their heirs and assigns, in fee simple, all that certain
lot or parcel of land situated in Jacksonville Township, Onslow
submitted electronically by "Gaylor Edwards Vatcher LawFirm"
in compliance with North Carolina statutes governing recordable documents
and the terms of the submitter agreement with the onslow County Register of Deeds.

County, North Carolina, and more particularly described as
follows :
See Exhibit "A"
TO HAVE AND TO HOLD the aforesaid lot or parcel of
land and all privileges and appurtenances thereto belonging to the
Grantees, their heirs and assigns in fee simple .
AND said Grantor doth hereby covenant that the property is
free and clear of all liens, encumbrances and defects of title
other than governmental regulations, zoning ordinances and utility
easements of record and that it will warrant and defend the title
to same against the lawful claim of all persons claiming by,
through, under or on account of it, but no further.
IN WITNESS WHEREOF, the Grantor has caused this instrument to
be signed in its corporate name by its duly authorized officers
and its seal to be hereunto affixed by authority of its City
Council, this the day and year first above written.
krie do.
1 •V.
- BY:
F-: Sammy Phillips, or
Attest: r'iii'NCPSk ''
��rraas«r��e
Rose R. Marshburn City Clerk

NORTH CAROLINA
ONSLOW COUNTY
I, —A t-,X..5 Z r-S-,nk , a Notary Public in
and for said County and State do hereby certify that Rose R.
Marshburn personally came before me this day and acknowledged that
she is City Clerk of the City of Jacksonville, a North Carolina
municipal corporation, and that by authority duly given and as the
act of the corporation, the foregoing instrument was signed in its
name by Sammy Phillips, its Mayor, sealed with its corporate seal
and attested by herself as its Clerk.
WITNESS my hand and notarial seal, this the .54hday of
APri\ , 2022 .
AAN ALEXIS ZAMECNIK
iarury: Onslow County
n,euo My Commission Expires
?;y 41aa,• March 23,2027
-- Notar Public
My Commission Expires : M arCv\ 23 I 2021

EXHIBIT "A"
Being all of the 8 . 03 acre tract of land, as shown on that plat
entitled "Plat of Recombination of Property at the Intersection of
Gateway North and Commons Drive North, Jacksonville Twp, Onslow
County, North Carolina, For: Library Site City of Jacksonville"
prepared by Parker & Associates, and recorded in Map Book 44 Page
130, Slide K-1797, Onslow County Registry.

DEPARTMENT OF TAX ADMINISTRATION 0 `"
Tax Certification Form
(Check One Box)
This certifies that there are no delinquent ad valorem taxes, or other
taxes which the Onslow County Tax Collector is charged with
collecting, that are a lien on:
Parcel Identification Number:
059876 GRANTEE: ONE PLACE, A NORTH CAROLINA
NON-PROFIT CORPORATION**, OF ONSLOW COUNTY
This is not a certification that this Onslow County Parcel
Identification Number matches the deed description.
nNo certification required, as attorney statement that any delinquent
taxes will be paid from closing proceeds is included on first page of
deed, and the assessor has obtained the desired information from the
conveyance (G.S. 105-303).
111 Balance due on account. It must be paid to Onslow County Tax Collector.
Please make payment within 5 days of closing.
KAREN D LEE oage1
2ozz o5 o209 2 ",0400, 05/02/2022
Tax Collections Staff Signature Date
nThis parcel may have deferred taxes which become due upon transfer of the
property. Call the Tax Office, Land Records Division at 910-989-2204 for
more information.
234 NW Corridor Blvd•Jacksonville,North Carolina•28540•Phone:[phone]•Fax:[phone] OnslowCountyNC.gov/tax