NCC192304_Annual Fee Payment Record_20201209

Action History (UTC-05:00) Eastern Time (US & Canada)
by Workflow 11/23/2020 4:52:54 PM (Workflow Start Event)
Submit by Selkane, Aziza 12/9/2020 9:06:50 AM (Annual Fee Payment Verification for NCC192304-2020)
* Donald A Moss Jr
• Selkane, Aziza assigned the task to Selkane, Aziza 12/9/2020 9:06 AM
The task was assigned to DEMLR NCG01 Annual Fee Team. The due date is: January 4, 2021 5:00
PM 11 /23/2020 4:52 PM

SfA7$ q,
NORTH CAROLINA
Envlrmmentuf Quuftty
Certificate of
NCC192304
Coverage (COC)
This is passed fromthe worKlow when the invoice is filed.
No. *
NC Reference COC
NCG01-2019-2304
No.*
Permit Status:
Active
Project Name *
187F Lake Rd.
Project Address*
187F Lake Rd., South Mills, NC
Permittee *
Donald A. & B. Marie Moss
County
Camden
Invoice No.*
NCC192304-2020
This is passed from the worldlow when the invoice is filed.
Annual Fee *
$ 100.00
Invoice Date*
11/24/2020
This is passed from the worldlow when the invoice is filed.
Invoice Due Date *
12/24/2020
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 Payme nt 12/9/2020
Received * Or, if WAIVBD or NDT FCBV®, this is the date that status is recorded.
Method of Payment* r electronic
f check
f other
ePayment 548045042
Transaction
Number*
Fee Status* PAID
Legally Responsible Donald Moss
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 * 12/9/2020