NCC202595_Contact Update Record (Site Contact and Leg Resp Change)_20220914

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Georgoulias, Bethany A 9/14/2022 9:22:47 AM (Contact Changes Submitted)

Certificate of NCC202595
Coverage (COC) No.* Enter the Certificate of Coverage Number (Use capital letters)
NC Reference No. NCG01-2020-2595
Original NOI No.* 27126
Project information associated with this permit (cannot change):
Permittee Listed Organizaiton cannot be changed (new COC required)
Forestar (USA) Real Estate Group, Inc.
Project Name Heritage at Moss Creek
Address Davidson Highway, Concord, NC
County Cabarrus
Latitude 35.4400
Longitude-80.7400
Date COC Issued * 06/29/2020
Prior Rescission Date This field will populate only if COC has already been rescinded.
Which Contacts Have Billing Only
Changed?* Legally Responsible Individual Only
Site Contact Only
• BOTH Legally Responsible Individual and Site Contact
Has Billing Contact Choose'Yes'to revise Billing Contact details.
Changed? U No
Yes
Billing Email
NEW Billing Email [e-mail]
Billing Telephone No.
NEW Billing [phone]
Telephone No. (Optional)
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible Mallie Colavita
Individual (Previous)
First Name (New)* Caleb
Last Name (New) * Saruse

NEW Legally Reflects any revisions above
Responsible Caleb Saruse
Individual*
Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee Telephone [phone]
No. (Previous)
NEW Permittee [phone]
Telephone No.*
Permittee Mailing 481 Munn Road East, 0, Fort Mill, SC 29715
Address (Previous)
NEW Permittee
Mailing Address*
Permittee Street
Address (Previous)
Street Address
481 Munn Road East
Address Line 2
Suite 150
City
Fort Mill
Postal / Zip Code
29715
State / Province / Region
Sc
Country
US
481 Munn Road East, 0, Fort Mill, SC 29715
NEW Permittee Street Street Address
Address* 481 Munn Road East
Address Line 2
Suite 150
City
Fort Mill
Postal / Zip Code
29715
State / Province / Region
Sc
Country
US
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact Steven Jackson
(Previous)
Site Contact Title Development Manager
(Previous)
Organization Forestar (USA) Real Estate Group, Inc.
(Previous)
First Name (New)* Caleb
Last Name (New) * Saruse

NEW Site Contact*
Reflects any revisions above
Caleb Saruse
NEW Site Contact
Director of Land Development - Charlotte
Title
NEW Organization
Forestar (USA) Real Estate Group, Inc.
This field is not required on the NOI form and may not pre -populate.
Site Contact Email
[e-mail]
(Previous)
NEW Site Contact [e-mail]
Email*
Site Contact 704-913-8746
Telephone No.
(Previous)
NEW Site Contact [phone]
Telephone No.*
Site Contact Mailing 481 Munn Road East, 0, Fort Mill, SC 29715
Address (Previous)
NEW Site Contact Street Address
Mailing Address* 481 Munn Road East
Address Line 2
Suite 150
City
State / Province / Region
Fort Mill
Sc
Postal / Zip Code
Country
29715
us
Change Requested Caleb Saruse via email on 9/13/2022.
by: * Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date * 09/14/2022