NCC222776_NOI 101042 Payment Verification_20220804

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 8/2/2022 11:12:50 AM (NCG01 NOI Submission)
Approve by Broussard, Brooklyn C 8/3/2022 6:09:22 AM (Review - NOI 101042 Tillery Academy)
• The task was assigned to Broussard, Brooklyn C by round robin distribution 8/2/2022 11:18 AM
• The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: August 5, 2022 5:00 PM
8/2/2022 11:18 AM
by Workflow 8/3/2022 6:09:30 AM (Workflow Start Event)
Submit by Tran, Kieu M 8/4/2022 7:55:55 AM (Payment Verification for NCC222776)
F Chad Abbott
• Tran, Kieu M assigned the task to Tran, Kieu M 8/4/2022 7:55 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: September 14, 2022 5:00
PM 8/3/2022 6:09 AM

5 A7
Payment Verification
NORTH CAROLINA
Envlrmmm(af Quafhy
Project Name
Tillery Academy
Lot Numbers
(If listed on the eNOI)
NA
NC Reference No.*
NCG01-2022-2776
Certificate of
NCC222776
Coverage (COC) No.*
Invoice Date
8/3/2022
Initial Invoice No.
NCC222776-2022
Initial Fee
$ 100.00
Invoice Due Date
9/2/2022
Important: If you change the choice below to Payment NOT RECEIVED, the application will be rejected, and a COC will
not be issued. This is the ONLY way to reject an eNOI at this step.
Payment Received*
• Payment Received.
Payment NOT RECEIVED.
Payment Status
PAID
Date Payment
8/4/2022
Received *
(Or, if not received, date rejected for no payment)
Method of Payment*
• electronic
check
Other
ePayment
646529355
Transaction Number*
NOI Tracking No.
101042
Tracking ID referenced upon submittal
This is an Express
• No
Review Project
Yes
Project Tracking ID
NCC-MONTG-2022-Tillery Academy