NCG080668_2021 DMR_20220303 (2)

DocuSign Envelope ID: 01OF5C98-8881-4D1A-B57E-17COC9DFBAE3
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a
system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person
or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the
best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information,
including the p sI iW,9PpP- PrXd imprisonment for knowing violations."
Signature
Date
D022DC4EB...
For questions, contact your local Regional Office:
DEMLR Regional Office Contact Information:
ASHEVILLE REGIONAL OFFICE
2090 US Highway 70
Swannanoa, NC 28778
[phone]
RALEIGH REGIONAL OFFICE
3800 Barrett Drive
Raleigh, NC 27609
[phone]
WINSTON-SALEM REGIONAL OFFICE
450 Hanes Mill Rd, Suite 300
Winston-Salem, NC 27105
[phone]
FAYETTEVILLE REGIONAL OFFICE
225 Green Street
Systel Building Suite 714
Fayetteville, NC 28301-5043
[phone]
JULINGTON REGIONAL OFFICE
943 Washington Square Mall
Washington, NC 27889
[phone]
CENTRAL OFFICE
1617 Mail Service Center
Raleigh, NC 27699-1617
[phone]
MOORESVILLE REGIONAL OFFICE
610 East Center Avenue/Suite 301
Mooresville, NC 28115
[phone]
WILMINGTON REGIONAL OFFICE
127 Cardinal Drive Extension
Wilmington, NC 28405-2845
[phone]
SWU-264 - Generic Annual DMR
Last revised 610112018