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HomeMy WebLinkAboutNCC233634_FRO Submitted (3)_20231208 (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. Richard M Eddinger President/ owner Ty pr. t am Title or Authority i nature Date I, r—OP.‘_,_) , a Notary Public of the County of V-K5`. State of North Carolina, hereby certify that t,(ANN .e jam{ 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 day of , 20D i otary OAWNB GINS Notary Public-North Carolina COUNTY OF FORSYTH My commission expires c� -t 04.� ,A7 Commission