NCC242884_FRO Submitted_20240919

TOWN OF KNIGHTDALE FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
40'fi SEDIMENTATION POLLUTION CONTROL ACT
No person may initiate any land-disturbing activity on one or more acres as covered by the Town
of Knightdale Unified Development Ordinance before this form and an acceptable
erosion and sedimentation control plan have been completed and approved by Town of
Knightdale, Public Works Department, Stormwater Division. (Please type or print and, if the
question is not applicable, place N/A in the blank.)
Part A.
1. Project Name Mailman Post
2. Location of land-disturbing activity: Knightdale Town Limits r ETJ)
Highway/Street Mailman Road Latitude 35°46'47"N Longitude 78°27'34"W
3. Approximate date land-disturbing activity will commence: September, 2024
4. Type of development(residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off-site utilities and borrow/waste
areas):64808ves
6. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Eli Eisenstadt E-mail Address [e-mail]
Phone# [phone] Cell# [phone]
7. Landowner(s) of Record (attach accompanied page to list additional owners):
Mailman West Property LLC [phone] [e-mail]
Name(s) Telephone E-mail address
4 Bryant Park, Suite 200 4 Bryant Park, Suite 200
Current Mailing Address Current Street Address
New York NY 10018 New York NY 10018
City State Zip City State Zip
8. Deed Book No.019619 Page No.00078 Provide a copy of the most current deed.
Part B.
1. Person(s) or firm(s) who are financially responsible for the land-disturbing activity (Provide a
comprehensive list of all responsible parties on an attached sheet. Include requested information):
Mailman East Property LLC,Mailman West Property LLC [e-mail]
Name E-mail Address
4 Bryant Park, Suite 200 4 Bryant Park, Suite 200
Current Mailing Address Current Street Address
New York NY 10018 New York NY 10018
City State Zip City State Zip
Phone# [phone]

2. (a) If the Financially Responsible Party is not a resident of Wake County, identify a designated agent in
Wake County to receive any notice, process, pleading in any action or legal proceeding arising out of any
matter relating to the Town of Knightdale Erosion and Sedimentation Control Ordinance and/or
Land Disturbance Permit:
Corporation Service Company [e-mail]
Name E-mail Address
2626 Glenwood Ave, Ste 550 2626 Glenwood Ave, Ste 550
Current Mailing Address Current Street Address
Raleigh NC — Raleigh NC 27608
City State Zip City State Zip
Phone# [phone]
(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
Phone#
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.
Jason Davis Authorized Signatory
Type or print name Title or Authority
Signature Date
‘P\I, 1 ESQ , a Notary Public of the County of o[\'<gol'Y*T-V
A
State of f v ►Qrl hereby certify that 34\SC' V
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, thi6 —\ day of \) (" , 20 a y
.&A e—ti/Ndrp
Notary
SidFRESA RAMSAROOP � (02....J
20Z�
NOTARY PUBLIC My commission expires
MONTGOMERY COUNTY
MARYLAND
My Commission Expires June 02,2020

Additional Landowners of Record
Name: Mailman East Property LLC
Address:4 Bryant Park,Suite 200, New York, NY 10018
Phone: [phone]
Email:[e-mail]
Deed Book:019576
Page(s):00834,01051,01741