NCC193100_Annual Fee Payment Record_20201216

Action History (UTC-05:00) Eastern Time (US & Canada)
by Workflow 12/7/2020 5:21:56 PM (Workflow Start Event)
Submit by Selkane, Aziza 12/16/2020 8:20:02 AM (Annual Fee Payment Verification for NCC193100-2020)
p ReNu Life Extended
• Selkane, Aziza assigned the task to Selkane, Aziza 12/16/2020 8:19 AM
The task was assigned to DEMLR NCG01 Annual Fee Team. The due date is: January 18, 2021 5:00
PM 12/7/2020 5:22 PM

SfA7$ q,
NORTH CAROLINA
Envlrmmentuf Quuftty
Certificate of
NCC193100
Coverage (COC)
This is passed fromthe worKlow when the invoice is filed.
No. *
NC Reference COC
NCG01-2019-3100
No.*
Permit Status:
Active
Project Name *
ReNu Life: Traumatic Brain Injury Services
Project Address*
201 Windsor Creek Parkway, Goldsboro, NC
Permittee *
ReNu Life Extended, Inc
County
Wayne
Invoice No.*
NCC193100-2020
This is passed from the worldlow when the invoice is filed.
Annual Fee *
$ 100.00
Invoice Date*
12/8/2020
This is passed from the worldlow when the invoice is filed.
Invoice Due Date *
1/8/2021
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 12/16/2020
Received * Or, if WAN® or NOT FECBV®, this is the date that status is recorded.
Method of Payment* r electronic
f check
f other
ePayment 549178971
Transaction
Number*
Fee Status* PAID
Legally Responsible Diane Harrison
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 * 12/16/2020