NCC204883_NOI 34323 Payment Verification_20201028

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 10/27/2020 1:55:42 PM (NCG01 NOI Submission)
Approve by Morman, Alaina 10/28/2020 11:58:31 AM (Review- Construction NOI 34323)
• Morman, Alaina reassigned the task to Morman, Alaina 10/27/2020 1:57 PM
• The task was assigned to Clark, Paul by round robin distribution 10/27/2020 1:56 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: October 29, 2020 5:00
PM 10/27/2020 1:56 PM
Submit by Selkane, Aziza 10/28/2020 1:54:36 PM (Payment Verification for NCC204883)
* Daniel Whitley 111 DDS PA
• Selkane, Aziza assigned the task to Selkane, Aziza 10/28/2020 1:52 PM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: December 9, 2020 5:00
PM 10/28/2020 11:59 AM

SfA7$ q,
•
V.
• yrnent Verification
NORTH CAROLINA
Envlro me tufQuuftty
Project Name
Eastern Carolina Dental
NC Reference No.*
NCG01-2020-4883
Certificate of
NCC204883
Coverage (COC)
No. *
Invoice Date
10/28/2020
Initial Invoice No.
NCC204883-2020
Initial Fee
$ 100.00
Invoice Due Date
11/27/2020
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.
r Payment NOT RECEIVED.
Payment Status
PAID
Date Payme nt
10/28/2020
Received *
(Or, if not received, date rejected for no payrrent)
Method of Payment*
r electronic
r check
r NO PAYMENT RECEIVED
r Other
Check Number*
3044
NOI Tracking No.
34323
Tracking ID referenced upon subaittal
This is an Express
r No
Review Project
r Yes
Project Tracking ID
NCC-ONSLO-2020-Eastern Carolina Dental