HomeMy WebLinkAboutNCC222435_FRO Submitted_20220707FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
EXPRESS PERMITTING OPTION
No person may initiate any #and -disturbing activity on one or more acres as covered by the Act before this form
and an acceptable erosion and sedimentation control plan have been completed and approved by the Land
Quality Section, N.C. Department of Environmental Quality. Submit the completed form to the appropriate
Regional Office. (Please type or print and, if the question is not applicable or the e-mail address or phone
number is unavailable, place NIA in the blank.)
Part A.
1. Project Name The Embassy at Morehead City
2. Location of land -disturbing activity: County:Carteret City or Township Morehead City
Highway/Street_3822 Gaiantis Drive! Latitudetdeamal degrees) 34.73143 Longitude(decimal degrees) 76.76138
3. Approximate date land -disturbing activity will commence:7-5-2022_
4. Purpose of development
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 5.57
6. Amount of fee enclosed $2.100.00. The Express Permitting application fee is a dual charge. The normal
fee of $100.00 per acre (rounded up to the next acre) is assessed without a ceiling amount. In addition,
the Express Permitting supplement is $250 per acre up to eight acres, after which the Express Permitting
supplemental fee is a fixed $2,000.00 (Example: 8.10-acre application fee is $2,900). Checks should
be addressed to NCDEQ.
7. Has an erosion and sediment control plan been filed? Yes X Enclosed ❑ No ❑
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name: Kevin See E-mail Address: ksee(W-leobrownaroup.co_m
Prone: Office # 317-669-8404 Mobile #
9. Landowner(s) of Record (attach accompanied page to list additional owners):
HPG NC Morehead City, LLC
Name
802E 86th Street
Current Mailing Address
Indianapolis, IN 46240
City State Zip City
317-669-8404
Phone: Office # Mobile #
same
Current Street Address
same
State Zip
10. Deed Book No. 6 Page No.q 1 Provide a copy of the most current deed.
Part B.
1. Company{ies) who are financially responsible for the land -disturbing activity (Provide a comprehensive list
of all responsible parties on accompanied page.) if the company is a sole proprietorship or if the landowner(s) is
an individual(s), the name(s) of the owner(s) may be listed as the financially responsible party(ies).
HPG NC Morehead City, LLC
Company Name
802 E. 86th Street
Current Mailing Address
Indianapolis, IN 46240
City State Zip
Phone: Office # 317-669-8404
ksee leobrown rou .cam
E-mail Address
same
Current Street Address
same
City State Zip
Mobile # 317-430-4948
Note: If the Financially Responsible Party is not the owner of the land to be disturbed, include with this form
the landowner's signed and dated written consent for the applicant to submit a draft erosion and sedimentation
control plan and to conduct the anticipated land disturbing activity.
2. (a) If the Financially Responsible Party is a domestic company registered on the NC Secretary of State
business registry, give name and street address of the Registered Agent:
Name of Registered Agent
Current Mailing Address
City State Zip
Phone: Office #
E-mail Address
Current Street Address
City State Zip
Mobile #
Name of Individual to Contact (if Registered Agent is a company)
(b) If the Financially Responsible Party is not a resident of North Carolina, give name and street address
of the designated North Carolina agent who is registered on the NC Secretary of State business registry:
Corporation Service Company
Name of Registered Agent E-mail Address
2626 Glenwood Avenue Suite 550
Current Mailing Address
Raleigh, NC 27608
City State Zip
Phone: Office # 302-636-5400
Name of Individual to Contact (if Registered Agent is a company)
(c) If the Financially Responsible Party is engaging in business under an assumed name, give name under
which the company is Doing Business As. If the Financially Responsible Party is an individual, General
Partnership, or other company not registered and doing business under an assumed name, attach a copy
of the Certificate of Assumed Name.
Company DBA Name
(d) if order to facilitate Express Permitting, it is necessary to be able to contact the engineer or other
consultant who can assist in providing any necessary information regarding the plan and its preparation:
Stroud Enaineerinci P.A.
Engineering firm or other consultant
Linwood Stroud
individual contact person (type or print)
Istroud _stroudengineer.com
E-mail Address
252-756-9352
Phone: Office # Mobile #
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(s)
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 Party). I agree to provide
corrected information should there be any change in the information provided herein.
Thomas C. Eth Authorized Representative
Type or pri Title or Authority
)-ov-el 30 ZD�?�
Signature Date
a Notary Public of the County of KymrY
State of Indiana, hereby certify that 1L7 S • �uYY�1 +40, appeared personally before
me this day and being duly sworn acknowledged that the above form was executed by him/her.
Witness my hand and notarial seal, this � day of , 20c3la
❑EB�RAH 0 CLARK
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` t� .••• �'d+''r. Nolary Public. State of Indiana
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Notary
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= SEAL.
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*N My Commission Exp res
My commission expires
August 16, 2028
PREPARED BY. Beth F. Atkins, Howard, Stallings, From, Atkins, Angell & Davis, P.A., P.O. Box 975, New Bern, NC 28563
(WITHOUT BENEFTT OF TTTU EXAM NATION)
RETURN TO: GRANTEE
NORTH CAROLINA PARCELID OUT OF 637613242798000
REVEM7E STAMPS $1,850.00
CARTERET COUNTY
SPECIAL WARRANTY DEED
o If checked, the property includes the primary residence of Grantor.
THIS SPECIAL 'WARRANTY DEED made and entered into this the 2 day of
December, 2021, by and between BEST VENTURES, LLC, a North Carolina limited liability
company, whose address Is: PO Box 1198, Morehead City, North Carolina 28557, party of the fast
per;
-TO-
HPG NC MOREHEAD CITY LLC, a Delaware limited liability company, whose address
is: c/o Leo Brown Group, 802 E. 861h Street, Indianapolis, IN 46240, party of the second part;
WITNESSETH:
That said party of the first part in consideration of the sum of ONE HUNDRED AND
N0I100 ($100.00) DOLLARS and other good and valuable considerations to it paid by said party of
HOWARD, STALLIIti GS, FROM ATK NS,
ANGELL & DAVIS, P.A.
Attorneys at Law
New Bern, North Carolina
the second part, the receipt of which is hereby acknowledged, has bargained and sold, and by these
presents does grant, bargain, sell, and convey to said party of the second part, its successors and
assigns, a certain tract or parcel of land, lying and being in Carteret County, North Carolina, and
being more particularly described in Exhibit A incorporated herein by reference.
TO HAVE AND TO HOLD the aforesaid tract or parcel of land, and all privileges and
appurtenances thereto belonging to the said party of the second part, its successors and assigns, in
fee simple, to its only use and behoof forever.
The said party of the first part covenants that it has done nothing to impair such title as party
of the first part received, and party of the first part will warrant and defend the title against the
lawful claims of all persons claiming by, under or through party of the first part, except for the
exceptions hereinafter stated.
Title to the property hereinabove described is subject to the following exceptions:
l . Real property taxes for 2022 and subsequent years, not due and payable;
2. Easements or rights of way of record, if any;
3. Restrictive Covenants of record, if any.
HOWA.R.D, STALLiNGS, FROM ATKINS,
ANGELL & DAVIS, P.A.
Attorneys at Law
New Bern, North Carolina
IN TESTIMONY WHEREOF, the said party of the first part has executed this Deed under
seal, this day and year first above written.
BEST VENTURES, LLC,
a North Carolina limited lliabili
By: ' 1 f
Title: Marcellus J. Best, Jr
STATE OF NORTH CAROLINA
COUNTY OF CRAVEN
I certify that the following person(s) personally appeared before me this day, each
acknowledging to me that he or she voluntarily signed the foregoing document for the purpose
stated therein and in the capacity indicated: MARCELLUS J. BEST ., AS MANAGE .
Date: /z /-x z / :..o I. I --
DAVID R. RUFF FNOTARY PUBLIC
WAKE COUNTY �
STATE OF NORTH CAROLII�A
FmYCOIi+MISSION EXPIRES Z
(Official Seal)
NOTARY PUBL C
<. elv' , Notary Public
Notary's taped or printed name
My Commission Expires:
01l7/zoaI-
HOWARD, STALLINGS, FROM ATKINS,
ANGEI.,L & DAVIS, P.A.
Attorneys at Law
New Bern, North Carolina
EXHIBIT A
BEING ALL of Lot 2 as shown on that plat entitled "FINAL SUBDIVISION PLAT FOR BEST
VENTURES LLC" and recorded in Plat Book 34, Page 345, Carteret County Registry.
HOWARD, STALLINGS, FROM ATKINS,
ANGELL & DAVIS, P.A.
Attorneys at Law
New Bern, North Carolina
OWNER AFFIDAVI7 AND INDEMNITY AGREEMENT
(NO RECENT IMPROVEMENTS AND NO EXECUTORY CONTRACTS FOR IMPROVEMENTS)
PARTIES: All parties identified in this section must execute this Agreement.
Owner: BEST VENTURES LLC
(NOTE- A separate Agreement is required for each successive owner in the 120-Day Lien Period.)
PROPERTY: SEE EXHIBIT A ATTACHED HERETO AND INCORPORATED HEREIN
(Insert street address or brief description and/or attach a description as Exhibit A. include here any real estate that is a portion of a larger, previously
unsegregated tract when that area is reasonably necessary for the convenient use and occupation of Improvements on the larger tract.)
DEFINITIONS: The following capitalized terms as used in this Agreement shall have the taliowing meanings:
• Improvement: All or any part of any building, structure, erection, alteration, demolition, excavation, clearing, grading, filling, or landscaping, including trees and
shrubbery, driveways, and private roadways on the Property as defined below.
• Labor Services or Materials: ALL labor, services, materials for which a lien can be claimed under NCGS Chapter 44A, Article 2, including but not limited to
professional design services (including architectural, engineering, landscaping and surveying) and/or rental equipment.
■ Contractor: Any person or entity who has performed or furnished or has contracted to perform or furnish Labor, Services or Materials pursuant to a contract,
either express or implied, with the Owner of real property for the making of an Improvement thereon. (Note that services by architects, engineers,
landscapers, surveyors, furnishers of rental equipment and contracts for construction on Property of Improvements are often provided before there is visible
evidence of construction.)
• 120- Day Lien Period: The 120 days immediately preceding the date of recordation of the latter of the dead to purchaser or deed of trust to lender in the Office
of the Register of Deeds of the county in which the Property is located
• Owner: Any person or entity, as defined in NCGS Chapter 44A, Article 2, who has or has had any interest in the Property within the 120-Day Lien Period. For
the purposes of this Agreement, the term Owner includes: (i) a seller of the Property or a borrower under a loan agreement secured by the Property; (if) a
person with rights to purchase the Property under a contract and for whom an Improvement is made and who ordered the Improvement to be made; and
(iii) the Owner s successors in interest and agents of the Owner acting within their authority.
• Corn any: The title insurance company providing the title policy for the transaction contemplated by the parties herein.
• Pro : The real estate described above or on Exhibit A and any leaseholds, tenements, hereditaments, and improvements placed thereon.
. All defined terms shall include the singular or plural as required by context.
AGREEMENT: For good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, and as an inducement to the purchase of the
Property by a purchaser and/or the making of a loan by a lender secured by a deed of trust encumbering the Property and the issuance of a title insurance policy or
policies by Company insuring title to the Property without exception to liens for Labor, Services or Materials; Owner first being duly sworn, deposes, says and agrees:
1. Certifications: Owner certfes that at no time during the 120-Day Lien Period have any Labor, Services or Materials been furnished in connection with a
contract, express or implied, for Improvements to the Property (including architectural, engineering, landscaping or surveying services or materials or rental equipment
for which a lien can be claimed under NCGS Chapter 44A) nor have any Labor, Services or Materials been furnished on the Property prior to the 120-Day Lien Period
that will or may be completed after the date of this affidavit OR only minor repairs and/or alterations to pre-existing Improvements have been made and Owner certifies
such repairs and/or alterations have been completed and those providing Labor, Services or Materials for the repairs have been paid in full- The Owner further
certifies that no Mechanics Lien Agent has been appointed-
2. Reliance and Indemnification: This Agreement may be relied upon by the purchaser in the purchase of the Property, a lender to make a loan secured by a
deed of trust encumbering the Property and by Company in issuance of a title insurance policy or policies insuring title to the Property without exception to matters
certified in this Agreement The provisions of this Agreement shall survive the disbursement of funds and dosing of this transaction and shall be binding upon Owner
and anyone claiming by, through or under Owner.
Owner agrees to indemnify and hold purchaser, lender, and Company harmless of and from any and all loss, cost, damage and expense of every kind, and attorney's
fees, costs and expenses, which the purchaser, lender or Company shall or may incur or become liable for, directly or indirectly, as a result of reliance on the
certifications of Owner made herein or in enforcement of the Company's rights hereunder-
3. NCLTA Copyright and Entire Agreement: This Agreement and any attachments hereto represent the entire agreement between the Owner and the Company,
and no prior or contemporaneous agreement or understanding inconsistent herewith (whether oral or written) pertaining to such matters is effective
THIS IS A COPYRIGHT FORM and any variances in the form provisions hereof must be specifically stated in the blank below and agreed to in writing by the
Company.
No modification of this Agreement, and no waiver of any of its terms or conditions, shall be effective unless made in writing and approved by the Company. J
PROVIDING A FALSE AFFIDAVIT 1S A CRIMINAL OFFENSE
EXECUTION
PEST VENTURES LLC
SEAL
state of NC County of
Signed and swam to for affirmed) before me this day by
By-
Marc Ilus J. 8 t Jr. as Mana er
Printed vr7yped NamelTille M
J. t Jr, an er
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D V I D R. RU FF
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Printed or Typed Namefrille:
�Da�L-i
Nota Public
NOTARY PUBLIC
WAKE COUNTY
M Commission Expires. 0 i La t
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rerc n� esnnru retzri
_ -- MY COMMISSION EXPIRES_
0 North Carolina Land Title Association, March 2013
Farm No-1 OWNER AFFIDAVIT AND INDEMNITY AGREEMENT (NO RECENT IMPROVEMENTS)
1r:-:1 : 1lw:l
BEING ALL of Lot 2 as shown on that plat entitled "FINAL SUBDIVISION PLAT FOR BEST VENTURES
LLC" and recorded in Plat Book 34, Page 345, Carteret County Registry.
0 North Carolina Land T& Association, March 2013
Form No.1: OWNER AFFIDAVIT AND INDEMNITY AGREEMENT (NO RECENT IMPROVEMENTS)
1099 REAL ESTATE TRANSACTION FORM
Buyer: HPG NC MORE14EAD CITY LLC
File No.:
Seller(s) Name(s): Best Ventures, LLC, a North Carolina limited liabilit c mpany
Business Individual Trust 1 Estate — LLC -_X_
Tax ID # �y ' /Vc
seller'~ Mailing Address: I Z � r -le"?
Date of Closing:
7. oross Proceeds or Allocation: $
3. Address or Legal Description: 5.577 acres +/- Plat Book 34 Page 345 Carteret Co Regis
4. Check Here if Seller Received or Will Receive Property or Services as All of the Consideration
S. Buyer's Part of Real Estate Tax $
This is important tax information and is being furnished to the Internal Revenue Service. If you are required to file a return, a negligence penalty or otho
sanction will be imposed on you if this item is required to be reported and the IRS determines tlia4 it has not been reported. You are required bylaw to provide
us with your correct taxpayer identification number. if you do not provide us with your torrecI taxpayer identification number, you may be subject to civil or
criminal penalties imposed by law. I hem -by acknowledge receipt of "SELLER COPY" of this form. Under penalties of perjury, i cettifyi[fipt the number
shown on this statement is my correct taxpayer idcrrlification number. 7 7
Date: _ _Z, Z x Seller's Signature: By (SEAL)
flarceus J. Best, Jr,
agar
Finn Name:
Federal I.D. Number:
Mailing Address:
Date Submitted for Reporting.
INSTRUCTIONS TO SELLER
Generally, persom responsible for closing a real estate transaction must report the real estate proceeds to the internal Revenue Service and most furnish this
statement to you. If the real estate transferred was your main home, file FORM 2l 19, Sale of Your Home, with your ineome tax return even if you sold at a
loss of you did not replace your home 1£the real estate transferred was not your main home, report the transaction in the appheahle parts of FORM 4797, Sale
of Business Property, FORM 62 52 , Installment Sales Income, and m SCHEDULE D [FORM 104ft Caption Wins and Losses -
Box I Shows the date ol-closing-
Box 2 - Shows the gross proceeds from a real estate transaction Gross proceeds include cash and notes payable to you and notes assumed by the transferee
(buyer). It does not include the value of other property or service you received or are to receive. SEE BOX 4,
Box 3 Showa the address of the property transferred for a legal description of the property
Box 4 if' marked, shows that you received or will receive services or property (other than cash or n)tes) as pan of the consideration for the property
transferred. The value of any services or property (other than cash or notes) is not included in box 2.
Box 5 Shows any 1-cal estate tax on a residence charge d to the buyer at settlement. If you havc already paid the real estate tax for the period that included the
sale dale, subtract this amount From the amount already paid to determine your deductible real estate cost- But if you have already deducted the real estate tax
in a prior year, generally report this amount as income on the line fro "Other income" on Form 1040. For snore info multion, see Pub 523
FHIS FORM IS ISSUED IN LIEU OF FORM t099-S.
CERTIFICATE OF NONFOREIGN STATUS OF TRANSFEROR
Section 1445 of the Internal Revenue Code provides that a transferee (buyer) of a U.S.
real property interest must withhold tax if the transferor (seller) is a foreign person. To
inform the transferee (buyer) that withholding of tax is not required upon disposition of a
U.S. real property interest, the undersigned transferor hereby certifies the following:
1. Transferor is not a nonresident alien, foreign corporation, foreign partnership,
foreign trust, or foreign estate (as those terms are defined in the Internal
Revenue Code and Income Tax Regulations);
2. Transferor's taxpayer identifying number is 20 - 3_� G.L and,
3. Transferor's address is (,I ! it fo,
►u C. y IV C z 19x 7
The undersigned understands that this certification may be disclosed to the Internal
Revenue Service by the Transferee and that any false statement made here could be
punished by fine, imprisonment, or both.
Under penalties of perjury the undersigned declares that the undersigned has examined
this certification and to the best of the undersigned's knowledge and belief, it is true,
correct and complete.
Transferor:
BEST VENTURES,
SEAL)
Subscribed and sworn to before me, this 2 7-` day of December, 2021.
My Commission Expires:
(SEAL)
DAVID R. RUFF
NOTARY PUBLIC
WAKE COUNTY
STATE OF NORTH CAROLIP�R
MY COMMISSION EXPIRES � ;�
Notary Public
CONSENT OF THE MANAGERS OF
BEST VENTURES, LLC
TO AC71ON TAKEN WITHOUT MEETING
The undersigned, being the Managers of BEST 'DENTURES, LLC, do hereby
adopt the following resolutions by signing their unanimous written consent hereto, which
consent is given in lieu of a meeting.
SALE OF PROPERTY
WHEREAS, the Managers of the Company, in the exercise of their business
judgment, deem it to be in the best interest of the Company to sell the areal estate
described as Lot 2, 5.577 acres +1--, Plat Book 34, Page 345, Carteret County, Mombead
City, NC, for a sales price of $924,600A0 to HPG NC Morehead City LLC, a Delaware
limited liability company;
RESOLVED, that the Company shall be, and it hereby is, authorized to sell the
property for the amount above -referenced, upon such other terns and conditions as the
Managers of Company deem appropriate,
RESOLVED FURTHER, that Marcellus J. Best, Jr., a Manager of the Company
shall be, and he hereby is, authorized to take any and all action necessary to carry the
foregoing into effect, including, without limitation, the execution of any and all necessary
documents on behalf of the Company.
This the Z 2 0 ay of December, 2021.
BEST VENTURES, LLC
Funds Disbursement Selection Letter
RE: Party(ies): BEST VENTURES, LLC
Forwarding Address:
IIWe, the undersigned Seller(s), acknowledge that Ilwe will receive proceeds from
the closing of the above -referenced transaction. IIWe prefer the method checked
below as the method of delivery of the closing proceeds.
DEPOSIT INTO BANK ACCOUNT BY WIRE
LInj ACCOUNT NAME - T7 VE& 7 brg 3 L G C
BANK NAME - C) O
BANK ABAIROUTING NUMBER 2 D z4fr
ACCOUNT NUMBER z 4 voa Z 0 s o 3
PHONE NUMBER TO CALL FOR WIRE VERIFICATION
zrvy&j- q«-17-P-3?fir
If you select this option, please be aware that your bank Wray charge an
incoming wife fee, Closing Attorney has no knowledge of'or control over
this , fee, and it is not collected as a part of ' the settlement , fees. Closing
Attorney also has no control over the date and time the .funds will be
posted to your account.
❑ OVERNIGHT DELIVERY TO FORWARDING ADDRESS ABOVE
❑ U.S. MAIL (REGULAR DELIVERY) TO FORWARDING ADDRESS
ABOVE
PICKUP AT CLOSING LOCATION
❑ OTHER
Z2 U'll
Date
STATE OF NORTH CAROLINA
COUNTY OF CRAVEN
I certify that the following person(s) personally appeared before me this day,
each acknowledging to me that he or she voluntarily signed the foregoing document
for the purpose stated therein and in the capacity indicat : MARCELLUS J. BEST,
JR., AS MANAGER
Date: 1 z./ ?--1- 12-a i e (/
NOTARY PUBLIC
/ /--✓�Cf , Notary Public
DAVID R, l)11�� � Nota3v's tvped or printed name
•inTn nu ne I iC