NCC202009_Contact Update Record_20210510

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Georgoulias, Bethany A 5/10/2021 3:10:36 PM (Contact Changes Submitted)

Certificate of NCC202009
Coverage (COC) Enter the Certificate of Coverage Ninber (Use capital letters)
No.*
NC Reference No. NCG01-2020-2009
Original NOI No.* 25600
Project information associated with this permit (cannot change):
Permittee Listed
Organizaiton cannot be changed (new COC required)
State Employees' Credit Union
Project Name
Tabor City Branch
Address
1003 Pireway Rd, Tabor City, NC
County
Columbus
Latitude
34.1400
Longitude
-78.8660
Date COC Issued*
05/15/2020
Prior Rescission
This field will populate only if COChas already been rescinded.
Date
Which Contacts
f Billing Only
Have Changed?*
F Legally Responsible Individual Only
f Site Contact Only
r BOTH Legally Responsible Individual and Site Contact
Has Billing Contact
Choose'Yes'torevise Billing Contact details.
Changed?
r No
r Yes
Billing Email
NEW Billing Email [e-mail]
Billing Telephone
No.
NEW Billing [phone]
Telephone No. (Optional)
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible Karen High
Individual
(Previous)

First Name (New)* Paul
Last Name (New) * Barbour
NEW Legally Reflects any revisions above
Responsible Paul Barbour
Individual*
Permittee Email Karen. [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee 9197606607
Telephone No.
(Previous)
NEW Permittee [phone]
Telephone No.*
Permittee Mailing PO Box26807, 0, Raleigh, NC 27609-7152
Address (Previous)
NEW Permittee
Mailing Address*
Street Address
P.O. Box 26807
Address Line 2
City
Raleigh
Fbstal / Zip Code
27611
Permittee Street 3808 Six Forks Rd, 0, Raleigh, NC 27609-
Address (Previous) 7152
NEW Permittee
Street Address*
Street Address
4401 Creedmoor Road
Address Line 2
city
Raleigh
Fbstal / Zip Code
27613
State / Rovince / Fbgion
NC
Country
US
State / Fkovince / Region
NC
Country
US
Change Requested Rachel Forehand of SECU Property Construction via email on 5/10/2021
by: * Include any additional correspondence records in the Repository CDC folder.
Additional Information for this update to contact information:
Addional Prev. responsible individual retired.
Explanation
(Optional)
Date * 05/10/2021