NCC200386_Annual Fee Payment Record_20220221

Action History (UTC-05:00) Eastern Time (US & Canada)
by Workflow 1/29/2022 5:40:45 PM (Workflow Start Event)
Submit by EADS\amorman1 2/21/2022 1:09:42 PM (2022 Annual Fee Payment Verification for NCC200386-2022)
• EADS\amorman1 assigned the task to EADS\amorman1 2/21/2022 1:09 PM
• The task was assigned to DEMLR NCG01 Annual Fee Team. The due date is: March 14, 2022 5:00 PM
1/29/2022 5:40 PM

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Certificate of NCC200386
Coverage (COC) No. * This is passed from the workflow when the invoice is filed.
NC Reference COC NCG01-2020-0386
No. *
Permit Status: INACTIVE
Already Rescinded: 2/21/2022
This field appears if the permit has already been terminated.
Year COC Issued 2020
This field will be hidden.
Check previous years for outstanding fees (years that do not apply will be blank):
2020 Fee Status
2021 Fee Status PAID
WAIVE FEE? * • Yes, Payment Not Applicable
No, Payment Still Applies
Project Name* Twin Lakes Community Boland & Fitness Renovations
Project Address* 3701 Wade Coble Drive, Elon, INC
Permittee* Lutheran Retirement Ministries of Alamance County, North Carolina
County Alamance
Invoice No.* NCC200386-2022
This is passed from the workflow when the invoice is filed.
Annual Fee* $ 100.00
Invoice Date* 2/1/2022
This is passed from the workflow when the invoice is filed.
Invoice Due Date* 3/1/2022
This is passed from the workflow 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 • Fee Payment Received or Not Applicable.
Received* Fee Payment NOT RECEIVED.
Date Payment 2/21/2022
Received * Or, if WAIVED or NOT RECEIVED, this is the date that status is recorded.

ePayment
Transaction Number*
Check Number*
Fee Status* WAIVED
Legally Responsible Pamela Fox
Person (Orig.)
Original Permittee E- [e-mail]
mail *
CONFIRM Permittee [e-mail]
E-mail* Opportunity to modify problem e-mail address or permittee contact info
Original Site Contact [e-mail]
E-mail *
CONFIRM Site [e-mail]
Contact E-mail* Opportunity to correct problem e-mail address or site contact info
Original Billing E-mail (if available)
CONFIRM Billing E- Opportunity to correct problem e-mail address or billing contact info
mail
Billing Telephone No.
Permittee Email for [e-mail]
30-day Reminder This is the email for the 30-day reminder if needed (passed from workflow).
Site Contact Email for [e-mail]
30-day Reminder This is the email for the 30-day reminder if needed (passed from workflow)
Billing Contact Email
This is the email for the 30-day reminder if needed (passed from workflow).
for 30-day Reminder
Project Name for 30-
Twin Lakes Community Boland & Fitness Renovations
day Reminder
The project name is passed from workflow for the 30-day reminder
Permittee Name for
Lutheran Retirement Ministries of Alamance County, North Carolina
30-day Reminder
The permittee is passed from workflow for the 30-day reminder
County for 30-day
Alamance
Reminder
The county is passed from workflow for the 30-day reminder
Additional Billing Contact E-mails
Additional E-mail for
CC:
Review Date* 2/21/2022