NCC222472_FRO Submitted_20220726

4395
NEWSTYLE COMMUNITIES, INC. WELLS FARGO BANK V.A.
2125 SOUTHEND DR., UNIT 453
CHARLOTTE, NC 28203 11-24/1210
[phone]
01 /27/2022
PAY TO THE Gaston Count Natural Resources Departme ****** '
OFiOEli OF y P � 3,600.00
************THREE THOUSAND SIX HUNDRED AND 001900 DOLLARS************ DOLLARS
Gaston County Natural Resources Departme
1303 Dallas-Cherryville J _!
Dallas, NC 28034 -
MEMO , =- s
- ED SIGNATURE
-
NEWSTYLE COMMUNITIES, INC.
NewStyle Communities, Inc. 004395
VENDOR: 170016 Gaston County Natural Resources Departure
INVOICE DATE DESCRIPTION
GNRD 01/27/22 GNRD FRO EC
FROEC
NEWSTYLE COMMUNITIES, INC.
01/27/22
GROSS AMT
3.600.00
3,600.00
DISCOUNT NET PAID
.00 3,600.00
00 3,600.00
NewStyle Communities, Inc-
004395 01/27/22
VENDOR 170016 Gaston County Natural Resources Departme
INVOICE DATE DESCRIPTION GROSS AMT DISCOUNT
GNRD 01/27/22 GNRD FRO EC 3,600.00 .00
FROEC
3,600.00 .00
�R06UCf S50144 UM wlrf191063 ENVEICK Doluxo Corpora lon 1-800-328.0304 or www.daluroxom/shop
4395
4395
NET PAID
3,600.00
3,600.00
6927662300

Gaston County
f-e Jr Gaston Natural Resources Department
8 1303 Cherryville Highway, Dallas, NC 28034 Telephone: [phone]
18a
Soil Erosion & Sedimentation Control
s�
4�1 Financial Responsibility/Ownership
No person may initiate any land -disturbing activity on one (1) or more acres of property in all portions of
Gaston County, except for that property within the city limits of the incorporated municipalities of Gaston
County who have not adopted the Gaston County Soil Erosion & Sedimentation Control Ordinance,
before this form and an acceptable Soil Erosion & Sedimentation Control Plan have been completed and
approved by the Gaston County Natural Resources Department's staff.
(Please type or print and, if question is not applicable, place NIA in blank)
PART A:
1. Project Name The Courtyards of Gastonia
2. Location of land -disturbing activity
City Gastonia Highway/Street NC-2791South New Hope Rd
3. Approximate date land -disturbing activity will commence June 1 , 2022
4. Purpose of development (residential, commercial, industrial, etc.)
Residential
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas) 11.79
6. Amount of fee enclosed $ 3,600 (12 x $300)
9
0
10
Soil Erosion & Sedimentation Plan Filed? Yes X No
Landowner(s) of Record (Use blank page to list additional owners)
Catherine B Wilson Rev Trust
Name
CIO Parks H Wilson JR PO Box 901
Mailing Address
Belmont NC 28012
City State Zip
Telephone Number
Martha G Wilson Rev Trust
Name
501 Ves Rd Apt 13116
Mailing Address
Lynchburg VA 24503
City State Zip
Telephone Number
Indicate Deed Book and Page where deed(s) or instrument(s) are recorded
Deed Book 2020E Page 0171
Deed Book 5253 Page 0584
Tax Map No.148738, 148734, Block Lot No.
148735,148736
Page t

John D & Anne C Wilson
Name
700 Durant St Apt 201
Mailing Address
Chapel Hill NC 27517
City State Zip
Telephone Number

PART B:
1. Person(s) or firm(s) who are financially responsible for this land -disturbing activity
Name
2125 Southend Driye. Suite 453
Mailing Address
Charlotte INC 28203
City State Zip
704-837-8301
Telephone Number
Communities. Inc.
Name
Mailing Address
City State Zip
Telephone Number
2. If the Financially Responsible Party is not a resident of North Carolina, give name and street
QUUI C. JJ VI 0 IV VI LI! VQI VIII IQ QLJj-1 IL.
Name
Mailing Address Street Address
City State Zip Telephone Number
3. 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 Part is a Corporation give name and street address of the Registered Agent.
Name
Mailing Address Street Address
City State Zip Telephone Number
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 authority to execute instruments for the financially responsible person).
agree to provide corrected information should there be any change in the information provided
herein.
0 Au-& Vt Gcv YK kq?S+d
11h,#
ame Title or Authority
113► IZz
Sign Date
I, i OOL t ► , a Notate Public of the County of C�I m State of North
Carolina, hereby certify that YO (t_ k j�L,-u�Sc,- appeared personally be ore me this day
and being duly sworn acknowledged that the above form �� as executed by him.
P"p UA C>pWitness m h nd and notarial seal, this �I� day of V c1 +1uc, r 2 U2Z .
-7113l40.1
0`( AC? }J� otary SEAL My Commission Expires
File: Financial Responsibility -Ownership Form.mw
AUB�-\G J� Page 2
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