NCC221161_FRO Submitted_20220325

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Financial Responsibility/Ownership Form SPCA
See TOFV LDO, Section §9-1407 SOIL EROSION & SEDIMENTATION CONTROL and Town Standards and Specifications for
additional details.
Part A.
1. Project Name Circle K NT1 Hilltop
2. Location of land -disturbing activity: Highway/Street Sunset Cake Rd and 14 i I ItoI2 Needmore Rd
3. Approximate date land -disturbing activity will commence: October 2U21
4. Type of development (residential, commercial, industrial, institutional,etc.):
5. Total acreage disturbed or uncovered (including off -site utilities and borrow/waste areas): 5.6
6. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name E-mail Address vvazgan0.bowrnan.cam
Telephone [phone] Cell # 843-27G-0308
7. Landowner(s) of Record (attach accompanied page to list additional owners):
Evan Glen, LLC, Tony A & Johanna P Currin
Name E-mail Address
PO Box 1055
Current Mailing Address Current Street Address
Fuquay-Varina, NC 27526
City State Zip City State Zip
S. Deed Book No. 17100 Page No. 0814
Provide a copy of the most current deed.
Part B.
1. Person(s) or firm(s) who are financially responsible for the land -disturbing activity (Provide a comprehensive list of all
responsible parties on an attached sheet. Include requested Information):
Circle & Stores Inc
Name E-mail Address
1 100 Situs Court, Suite 100
Current Mailing Address Current Street Address
Ralei h NC 27606
City State Zip City State Zip
Telepho
Town of Fuquay-Varina E 401 Old Honeycutt Road, Fuquay-Varina, NC 27526
[phone] H fuquay-varina.org

2. (a) If the Financially Responsible Party is not a resident of Wake County, identify a designated agent in Wake County to
receive any notice, process, pleading in any action or legal proceeding arising out of any matter relating to the Town of
Fuquay-Varina Land Development Ordinance and/or Land Disturbance Permit:
Name
Current Mailing Address
City State Zip
E-mail Address
Current Street Address
City State Zip
Telephone
(b) If the Financially Responsible Party is a Partnership or other person engaging in business under an assumed name,
attach a copy of the Certificate of Assumed Name. If the Financially Responsible Party is a Corporation, give name
and street address of the Registered Agent:
Nferidith W. Rice, JR [e-mail]
Name E-mail Address
1100 Situs Caurt, Suite 100
Current Mailing Address Current Street Address
RalefiA. NC 27606
City State Zip
City State Zip
Telephone [phone]
The above information is true and correct to the best of my knowledge and belief and was provided by me under oath
(This form must be signed by the Financially Responsible Person if an individual or his attorney -in -fact, or if not an
individual, by an officer, director, partner, or registered agent with the authority to execute instruments for the Financially
Responsible Person). I agree to provide corrected information should there be any change in the information provided
herein.
Meridith W. Rice, JR
Type or print name Title or Authority
Vice President
Signature Dale
a Notary Public of the County of WLLL
State of North Carolina, hereby certify that £1 ���f�7 ��� IC C.� �i appeared personally
before me this day and being duly sworn acknowledged that the above form was executed by him.
Witness my hand and notarial seal, this Al day of I1 , 20,9/
ROBIN F. ALFOR❑
Seal NOTARY PUBLIC
Johnston County
North Carolina
My Commisalon Expires Aprll 23, 2023
tary
My commission expires

BKO1710OPGO0814
Excise Tax: $ 0,
WAKE COUNTY, NC
CHARLES P. GILLIAM
REGISTER OF DEEDS
PRESENTED & RECORDED ON
04-18-2018 AT 09:05:21
BOOK: 017100 PAGE: 00814 - 00818
Tax Lot No.. Ol 77061, 162531, 421903 _ Parcel Identif er No,
Verified by Wake Coun on the; day of , 20 b
Mail after recording; to: GRANTEE
This instrument was prepared by: Curnalander Adcock, LLP
By. James S. Adcock III (without title examination or closing)
(Post Office Box 1055, Fuquay-Varina, NC 27526)
Brief Description for the index 'h undivided interest in 1.33 acres and 2.327 acres,
Sunset Lace Road; '/ undivided interest in 300 Judd
Place Drive
IRTH CAROLINA GENERAL WARRANTY DEED
THIS DEED made this a of April, 2018 by and between
MiUNIF � .
Cumalander Company, LLC, a North Carolina
limited liability company (a A undivided interest)
Post Office Box 1055
Fuquay-Varina, NC 27526
❑If checked, this property is a personal residence.
GRANTEE
Evan Glen, LLC, a North Carolina
limited liability company
Post Office Box 1055
Fuquay Varina, NC 27526
linter In appropdato block ror each pwiy: name, addr s% and, Ifeppi-op Hal c, character of entity, c.g., corporation orpnrtncrship.
The designation Grantor and Grantee as used herein shall include said parties, their heirs, successors, and assigns,
and shall include singular, plural, masculine, feminine or neuter as required by context.
WITNESSETI-1, that the Grantor, for a valuable consideration paid by the Grantee, the receipt of which is hereby
acknowledged, has and by these presents does grant, bargain, sell and convey unto the Grantee in fee simple, all
that certain lot or parcel of land situated in the Town of Fuquay-Varitia, Middle Creek Township, Wake County,
North Carolina and more particularly described as follows:
Submitted electronically by "Cumalander Adcock, LLP"
in compliance with North Carolina statutes governing recordable documents
and the terms of the submitter agreement with the wake County Register of oeeds.

BKO17100PG00815
SEE ATTACHED SCHEDULE A
The property hereinabove described was acquired by Grantor by instrmment recorded in Book 9048, Page 1704,
(Parcel 1); Book 12282, Page 193 (Parcel 2); and Book 15686, Page 2210 (Parcel 3), Wake County Registry.
A map showing the above -described property is recorded in Book of Maps 1987, Page 153 (Parcel 2), and Book
of Maps 2014, Page 621 (Parcel 3).
TO HAVE AND TO HOLD the aforesaid lot or parcel of land and all privileges and appurtenances thereto
belonging to the Grantee in fee simple.
And the Grantor covenants with the Grantee, that Grantor is seized of the premises in fee simple, has the right to
convoy the same in fee simple, that title is marketable and free and clear of all encumbrances, and that Grantor
will warrant and defend the title against the lawful claims of all persons whomsoever except for the exceptions
hereinafter stated.
Title to the property hereinabove described is subject to the following exceptions:
1. All general utility, service easements and rights of way of record.
2, Those restrictive covenants recorded in Book 5689, Page 129, Wake County Registry (Parcel 1).
3. Those restrictive covenants recorded in Book 8804, Page 2299, Wake County Registry, and that Mutual
Cross Access Easement Agreement and Sign Easement recorded in Book 8804, Page 2747, Wake County
Registry, and Declaration of Covenants, Conditions and Restrictions Commonwealth Commons recorded
in. Book 15686, Page 18, Wake County Registry (Parcel 3).
4. 2018 Ad Valorem real property taxes, not yet due and payable.
1N WITNESS WHEREOF, the Grantor has hereunto set his hand and seal, or if corporate, has caused this
instrument to be signed in its corporate name by its duly authorized officers and its seal to be hereunto affixed by
authority of its Board of Directors, the day and year first above written.
Cumalander Company, LLC, a North Carolina
Limited Liability Company
f /I (SEAL)
W. Wark Cumalander, Member/Manager

BKO1710OPGO0816
NORTH CAROLINA
WAKE COUNTY
1 certify that the following person(s) personally appeared before me this day, each Acknowledging to me
(hat he or she voluntarily signed the foregoing document for the purpose stated therein and in the capacity indicated;
W. Mark Cumalander. as Member/lAnnager of Cumalander Company, LLC a North Carolina Limited Liabilitv Company.
Wit y d d a vial stamp or seal this � day of April, 201 S.
� Notary Public ,,{lllillr,,
.� ' .%.+'S 5. ADOO
r,•w+-t: �. -oc (printed name) . C,
My commission expires: -t1 o 1 a'ja a
.;c ❑UN
"tillllll{Vj1

BKO1710OP000817
SCHUULE A
Parcel Y
Th�a property is located at the intereactior. of
Sunset Lake Road SR 1301 and Hilltop Needxuc; a Read SR 1393 &ad
being a portion of 'the W.D. Sear propaa:ty described in Deed LYook
81o, Page B2, wake County Registry,
S aginaiAg at an exlpting spike aet La the center of th -_ c.b)oye-
referenced intersection running thence along eho gamer l,i7a of vR
1301 North 42 degrees 51 minutes 32 saconda Mast 8$, 16 feat to a pk
aail; rune thence North 42 degrees 15 minutes 17 seconds west 71.99
feat to an existing railroad spike set .in the canter 1.d.ne of sR
1301; thence North 61 degrees 31 minutes 46 seconds ;vast 332.97
feet to an existing iron stake set is the boundary of W.0, Ranadakl
heirs/ thence South 23 degrees 22 minutes 16 seconds East U0 .03
teat to an iroa pj.pe set approximately 12.49 feat across t l a cenzex
line of SR 1393; thenca approximataly with Lhe cenjYer I'-
c of SR
1393 the tollowing courams and distances; South 50 degrees 15
miautas 30 seconds Wrist 50:08 filet, South 85 degrees 2 minutes 30
seconds West 50,05 feet, South 88 degrees 21 minutes 45 seconds
West 50.04 feet:, North 9e degrees Z raiauto 35 seconds Went $0,06
feete as degrees 10 m1autes 55 seconds .West 50.09 feet to the paint
&nd place of bagginning set in the intersection of •-Sunset Laka Road
SR 1301 and Hilltop Neadrtora Road SR 1393, This being 1.33 acres
less .27•acres in the right of ways of SR 1301 and SR 1393 tar a
total, of 1.06 acres more or lase accord,iag to n survey by Thorspson
& Associates dated auly'10, 1989.
(a `/ undivided interest in the above -described Parcel 1)
Parcel 2:
Being ail of (hat 2.327 acres, more or less, as shown on that map entitled "S«rveyed and Mapped for Bryant H.
Clark and wife, Lois H. Clark" prepared by Stancii & Associates, Registered Laird Surveyor, P.A. dated January
16, 1997 and recorded in Book of Maps 1997, Page 153, referenced to which is hereby made for greater certainty
of description.
Ni undivided interest in the above -described Parcel 2)

BKO 1710OPGO0818
Parcel 3:
Being all of Lot 1, containing 3332 square feel, more or toss, as shown on that map entitled
"Office Unit Map For: RC I'uquay, I..L-C,", prepared by Mauldin - Watkins Surveying, P.A.,
dated May 2, 2014 and revised May 12, 2014, and recorded in Book of Maps 2014, Page 621,
Wake County Registry, reference to which is hereby made for greater certainty of description.
Together with all those rights and privileges in all common areas and common elements inuring
to each Owner, along with all obligations appertaining thereto, pursuant to that Declaration of
Covenants, Conditions and Restrictlonq Commonwealth Commons recorded in Book
Page I � , Wake County Registry.
(V2 undivided interest in the above -described Parcel 2)