NCC190568_Annual Fee Payment Record_20201119

Action History (UTC-05:00) Eastern Time (US & Canada)
by Workflow 10/27/2020 7:10:05 AM (Workflow Start Event)
Submit by Selkane, Aziza 11/19/2020 4:46:11 PM (Annual Fee Payment Verification for NCC190568-2020)
* NC Department of Transportation
• Selkane, Aziza assigned the task to Selkane, Aziza 11/19/2020 4:45 PM
The task was assigned to DEMLR NCG01 Annual Fee Team. The due date is: December 8, 2020 5:00
PM 10/27/2020 7:10 AM

SfA7$ q,
NORTH CAROLINA
Envlrmmentuf Quuftty
Certificate of
NCC190568
Coverage (COC)
This is passed fromthe worKlow when the invoice is filed.
No. *
NC Reference COC
NCG01-2019-0568
No.*
Permit Status:
Active
Project Name *
Triangle Tyre
Project Address*
US 64 Alt West, Tarboro, NC
Permittee *
NC Department of Transportation
County
Edgecombe
Invoice No.*
NCC190568-2020
This is passed from the worldlow when the invoice is filed.
Annual Fee *
$ 100.00
Invoice Date*
10/27/2020
This is passed from the worldlow when the invoice is filed.
Invoice Due Date *
11/27/2020
This is passed from the woMlow when the invoice is filed.
An automated email reminder is sent to the permittee when the invoice is due. Wait until invoice is 15 days overdue
before proceeding to a Notice of Deficiency.
Important: If you change the choice below to Payment NOT RECEIVED, the fee status becomes PAST DUE, and the
permittee will receive a Notice of Deficiency.
Annual Fee Payment r Fee Payment Received or Not Applicable.
Received* r Fee Payment NOT RECEIVED.
Date Payment 11/19/2020
Received * Or, if WAN® or NOT FECBV®, this is the date that status is recorded.
Method of Payment* r electronic
IT check
f other
Check Number* 4223990
Fee Status* PAID
Legally Responsible Ronnie Keeter
Person (Orig.)

Original Permittee E- [e-mail]
mail *
CONFIRM Permittee [e-mail]
E-mail * Opportunity to rrodify problem e-mail address or perrrittee contact info
Original Site Contact [e-mail]
E-mail *
CONFIRM Site [e-mail]
Contact E-mail * Opportunity to correct problem e-rrail address or site contact info
Additional Billing Contact E-mails
Additional E-mail for
CC:
Review Date * 11/19/2020