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Home My WebLink AboutNCC222227_FRO Submitted_20220701FINANCIAL RESPONSIBILITY/OWNERSHIP STATEMENT As per 15A NCAC 04B .0118 — The draft Erosion and Sediment Control Plans will not be approved until an authorized statement of financial responsibility and ownership is submitted. As per GS I I3A-54.1(a) - If the applicant is not the owner of the land to be disturbed, the owner's written consent for the applicant to submit a draft Erosion and Sediment Control Plan and to conduct the anticipated land -disturbing activity must be submitted with this document. PART A. 1. Project Name: Parking Deck 2. Physical Address/Location: StrcetAddress: 806 Intemational Avenue city: High Point statc: NC zip: 27268 3. Latitude: 35.9675 Longitude:-79.9979 4. Approximate date land -disturbing activity will commence: May, 2022 5. Purpose of development (residential, commercial, industrial, etc.) Institutional 6. Approximate acreage of land to be disturbed or uncovered: 3.5 Acres 7, Landowner(s) of Record (use blank page to list additional owners): High Point University Name Name One University Parkway Current Mailing Address Current Mailing Address High Point, N.C. 27268-0001 City, State, Zip City, State, Zip 336-841-9046 Telephone Number Telephone Number 8. Indicate book and page where deed or instrument is filed (use blank page to list additional deeds or instruments). Provide copies of Deeds with this submittal. Book 7271 :371,, Page 2777 Page - FinResFm. Page # 1 PART B. 1. Person(s) or firm(s) who are financially responsible for this land -disturbing activity: Jfth Point Universily Name Name One University Parkway Current Mailing Address Current Mailing Address High Point, N.C. 27268-0001 City, State, Zip City, State, Zip 336-841-9046 Telephone Number Telephone Number 2. Registered agent, if any, for the person or firm who is financially responsible: Signature Mailing Address Printed Name Telephone Number 3. 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 if not an individual, by an officer, director, partner or attorney -in -fact, or registered agent with authority to execute instruments for the financially responsible party.). I agree to provide corrected information should there be any change in the information provided herein. Deborah L. Shutters Type or Print Name A��4-'-j Signature Vice President for Financial Affairs Title of Authority .l q2 Date I,Vli�' . a Notary Public of the County of State of North Carolina, do hereby certify that 19 , — L , Skalfc, 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 ��k_day of A0Z,,2, . Notary Public Jennifer Firestine My commission NOTARY PUBLIC Guilford County North Carollna My Commiselon Expires Judy 21, 2024 -- !M &�MMFj"W=M*A FinResFm. Page # --- •-•- --Z- -. . 111111111111R111111111 2077046879 GUILFORD CO, NC FEE $2S.00 STATE OF NC REAL ESTATE EXTX $360.00 PRESENTED. RCCORDEW 09-09-2011 03:57:50 PM JEFF L. TH{GPEN REUTER OF OMS BY: MARY MOMAN DEPUTY -HA BK: R 7271 PG: 2777-2779 NORTH CAROLINA GENERAL WARRANTY DEED Excise Tax: $360.00 Parcel Identifier No. Verified by County on the day of , 20_ By: Mail/Box to: ROBERSON, HAWORTH & REESE, P.L.L.C., P.O. Box 1550, High Point, NC 27261 This instrument was prepared by: Elizabeth M. Koonce, Attorney -at -Law Brief description for the Index: Lot 8 and part of Lot 9, Block G, Willoubar Terrace, PB 4, PG 132 THIS DEED made this 9th day of September, 2011, by and between GRANTOR CHARLIE C. DAVIS, SR., unmarried 606 Montlieu Avenue High Point, NC 27262 GRANTEE HIGH POINT UNIVERSITY 833 Montlieu Avenue High Point, NC 27262 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. WTTNESSETH, 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 City of High Point, High Point Township, Guilford County, Korth Carolina and more particularly described as follows: See Exhibit A attached hereto and made a part hereof as if fully set out herein. The above described property („X j does/(__) does not include the primary residence of the Grantor. The property hereinabove described was acquired by Grantor by instrument recorded in Book 6037, Page 1153. The map showing the above described property is recorded in Plat Book 4, Page 132. 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 convey 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, other than the following exceptions: RIGHTS OF WAY, EASEMENTS AND RESTRICTIONS OF RECORD, IF ANY, AND TO AD VALOREM TAXES. IN WITNESS WHEREOF, the Grantor has duly executed the foregoing as of the day and year first above written. r(SEAL) Charlie C. Davis, Sr. State of North Carolina County of Guilford I, Elizabeth M. Koonce, a Notary Public of the County and State aforesaid, certify that the following person who is known to me or proved to me on the basis of satisfactory evidence to be the person described, personally appeared before me this day, acknowledging to me that he voluntarily signed the foregoing instrument for the purpose stated therein and in the capacity indicated: Charlie C. Davis, Sr. Date: q1q1,Ao % 1 Elizabeth DW. Koonce, Notary Public Notary's Printed or Typed Name (Official/Notarial Seal) My Commission Expires: 9/13/2011 iMTSIT A PROPERTY DESCRIPTION TRACT ONE BSINO ALL OF LOT NUMBER 8 OF BLOCK AT S SHOWN AT f THE DW OF THE WILLOUBAR TERRACE AS RECORDED NORTH OF$ICH OF THE REGISTER PDEEDS OF PORTIOF SAID L8 TAMM BY CAROLINA, SAVE AND EXCZ RIGHT OF My OF MONTL"M AVENUE' TRACT TWO BSOINNI at as existing iron pin in the southe 8° West of way line of Montlieu Avenue, same being South 84 3 1 feet front the western right of way line of 5Fi Fifth Street ; from said BegiUuing Point running feet to an existing iron pin in the northern line of Lot 15; oint thence South 84°8143" West 47•5 feet I you or l aci^ner eg Lot 8 the southwest corner of Lot 9 and of Willoubar Terrace; point the southern West 177.25 o£ way line of more or leas, to a point more Or Montlieu Avenue; thence North wayaline of Montlieu Avenue to less, along the sou art of Lot 9 the point and place of Beginning. The f re being p of Willoubar Terrace as per plat thereof recorded in Plat Hook 4, 'at page 132 in the Office of the Register Of eee hown on Guilford County, North Carolina; and being the Property surrey prepared by Davie -Martin -Powell & Assoc' Inc. dated 12-20- oo Job -No. S-4247. The'above described property is conveyed together with heand including all right, title and interest (i y) o Grantor in and to the alleyway abutting the West property line of Lot 8. 0.