NCC203821_Contact Update Record_20211018

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Selkane, Aziza 10/18/2021 3:23:44 PM (Contact Changes Submitted)

Certificate of
NCC203821
Coverage (COC) No.*
Enter the Certificate of Coverage Number (Use capital letters)
NC Reference No.
NCG01-2020-3821
Original NOI No.*
30703
Project information associated with this permit (cannot change):
Permittee Listed Organizaiton cannot be changed (new COC required)
Charlotte Mecklenburg Housing Partnership, Inc.
Project Name Walden Ponds
Address 1701 Tom Sadler Road, Charlotte, NC
County Mecklenburg
Latitude 35.2901
Longitude-80.9564
Date COC Issued * 09/08/2020
Prior Rescission Date This field will populate only if COC has already been rescinded.
Which Contacts Have Billing Only
Changed?* Legally Responsible Individual Only
Site Contact Only
• BOTH Legally Responsible Individual and Site Contact
Has Billing Contact Choose'Yes'to revise Billing Contact details.
Changed? • No
Yes
Billing Email
Billing Telephone No.
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible
Julie Porter
Individual (Previous)
First Name (New)*
Julie
Last Name (New)*
Porter
NEW Legally
Reflects any revisions above
Responsible
Julie Porter
Individual*

Permittee Email
(Previous)
NEW Permittee
Email*
[e-mail]
[e-mail]
Permittee Telephone [phone]
No. (Previous)
NEW Permittee 7043420933
Telephone No.*
Permittee Mailing 4601 Charlotte Park Drive, Suite 350,
Address (Previous) Charlotte, NC 28217
NEW Permittee Street Address
Mailing Address* 4601 Charlotte Park Drive
Address Line 2
Suite 350
City
State / Province / Region
Charlotte
NC
Postal / Zip Code
Country
28217
us
Permittee Street 4601 Charlotte Park Drive, Suite 350,
Address (Previous) Charlotte, NC 28217
NEW Permittee Street Street Address
Address* 4601 Charlotte Park Drive
Address Line 2
Suite 350
City State / Province / Region
Charlotte NC
Postal / Zip Code Country
28217 us
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact Sammy Jackson
(Previous)
Site Contact Title
(Previous)
Organization Charlotte Mecklenburg Housing Partnership, Inc.
(Previous)
First Name (New)* Sammy
Last Name (New) * Jackson
NEW Site Contact* Reflects any revisions above
Sammy Jackson
NEW Site Contact
Title

NEW Organization Charlotte Mecklenburg Housing Partnership, Inc.
This field is not required on the NOI form and may not pre -populate.
Site Contact Email [e-mail]
(Previous)
NEW Site Contact [e-mail]
Email*
Site Contact 7043420933
Telephone No.
(Previous)
NEW Site Contact 7043420933
Telephone No.*
Site Contact Mailing 4601 Charlotte Park Drive, Suite 350,
Address (Previous) Charlotte, NC 28217
NEW Site Contact Street Address
Mailing Address* 4601 Charlotte Park Drive
Address Line 2
Suite 350
City
State / Province / Region
Charlotte
NC
Postal / Zip Code
Country
28217
us
Change Requested Sammy Jackson by email on 10/18/2021
by: * Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date * 10/18/2021