NCC191916_Payment Verification_20190918

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 9/16/2019 6:24:01 PM (NCG01 NOI Submission)
Approve by Georgoulias, Bethany 9/17/2019 8:51:36 AM (Review- Construction NOI 15965)
• The task was assigned to Georgoulias, Bethany by round robin distribution 9/16/2019 6:24 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: September 18, 2019 5:00
PM 9/16/2019 6:24 PM
Submit by McCoy, Suzanne 9/18/2019 7:49:38 AM (Payment Verification for NCC191916)
* Wilmington Eye, PA
• McCoy, Suzanne assigned the task to McCoy, Suzanne 9/18/2019 7:48 AM
• The task was assigned to DEMLR NCG01 Payment Team. The due date is: October 29, 2019 5:00 PM
9/17/2019 8:51 AM

Payrmnt Verification
NORTH CAROLINA
Envtr"mmWiQvuAty
Project Tracking ID*
NCC-NEW H-2019-Wilmington Eye at Scotts Hill Medical Park
NC Reference No.*
NCG01-2019-1916
Certificate of
NCC191916
Coverage (COC)
No. *
Important: If you change the choice below to Payment NOT RECEIVED, the application will be rejected, and a COC will
not be issued. This is the
ONLY way to reject an eNOI at this step.
Payment Received*
r Payment Received.
f Payment NOT RECEIVED.
Date Payment
9/18/2019
Received*
Method of Payment*
r electronic
r check
r NO PAYMENT RECEIVED
r Other
e Payme nt
480017054
Transaction
Number*
NOI Tracking No.
15965
Tracking ID referenced upon subnittal
This is an Express
r No
Review Project
r Yes