NCC203125_Contact Update Record_20210825

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Selkane, Aziza 8/25/2021 11:01:58 AM (Contact Changes Submitted)

Certificate of NCC203125
Coverage (COC) Enter the Certificate of Coverage Ninber (Use capital letters)
No.*
NC Reference No. NCG01-2020-3125
Original NOI No.* 28568
Project information associated with this permit (cannot change):
Permittee Listed Organizaiton cannot be changed (new OOC required)
Benjamin Stout Real Estate Services, Inc
Project Name
Cameron Vista - Lots 1, 2 & 3
Address
Majestic Court, Greenwood, NC
County
Moore
Latitude
35.3093
Longitude
-79.2693
Date COC Issued*
07/29/2020
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This field will populate only if COChas already been rescinded.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
(Optional)
Telephone No.
Change Requested
Ben Stout
by: *
Include any additional correspondence records in the Pepository COCfolder.
Additional Information
for this update to contact information:

Addional
Explanation
(Optional)
Date * 08/25/2021