NCC223564_FRO Submitted_20221024

No person may initiate any land -disturbing activity on twenty (20) thousand square feet or more before this form has been
completed and filed with the Town of Apex Water Resources Department.
PART A
Name of Project: Colby Crossing (Residential Development)
Location of Land -Disturbing Activity: 7.58 acre parcel located at the eastern dead-end of Colby Chase Drive from Pemberly subdivision
Approximate Date Land -Disturbing Activity will Commence: November 2022
Acreage of Land to be Disturbed: 2.98 acres
Latitude:
35.6926
Longitude:
-78.8234
Land Owner(s) of Record (use blank page to list additional owners):
PART B
Name: Horton Park Investments, LLC
Current Mailing Address:
6908 North Ridge Drive
Name:
Current Mailing Address
City, State, Zip: Raleigh, NC 27615 City, State, Zip
Person or firm financially responsible (developer) for this land disturbing activity. Financial responsibility includes, but
may not be limited to: payment of civil fines and criminal penalties and any other costs associated with bringing the
project into compliance with the Town of Apex Soil Erosion and Sedimentation Control Ordinance.
Name of Person or Firm: Horton Park Investments, LLC
Telephone: [phone]
Current Mailing Address:
6908 North Ridge Drive
City, State, Zip: Raleigh, NC 27615
E-mail: [e-mail]
Street Address (if different from mailing address)
City, State, Zip
Revised 911912019 Page 1

If the financially responsible party is not a resident of Wake County, complete the following for an appointed agent, in
Wake County, to receive any notice, process, pleading in any action or legal proceeding arising from a violation of the
Town of Apex Soil Erosion and Sedimentation Control Ordinance. By signing below, it is agreed that any notice, process,
or pleading against the person or firm who is financially responsible for this land -disturbing activity may be served on
the undersigned and shall be of the same force and effect as if served on the financially responsible person or firm. The
intent of this provision is to establish the presumption that the constructive notice from the Town of Apex will be
addressed through the undersigned agent.
Name:
Telephone:
Current Mailing Address:
City, State, Zip:
Signature:
Street Address (if different from mailing address)
City, State, Zip
If the financially responsible party is a partnership or other person engaging in business under an assumed name, complete
Page 4 of this form, or attach a copy of the Certificate of Assumed Name or Partnership as recorded in the Register of
Deeds. If the financially responsible party is a corporation, complete the information on Page 5 of this form and submit a
current copy of the Annual Report as filed with the Secretary of State.
The information contained in this form is true and correct to the best of my knowledge and belief and was provided by
me while under oath. (This form must be signed by the financially responsible person if an individual or by an officer,
director, partner, or registered agent with authority to execute instruments for a corporation or partnership if it is the
financially responsible party). I agree to provide corrected information should there be any change in the information
provided herein.
Name: Pablo Reiter Date: %0 /1(LZ2
Title or Authority: Manager
Signature:
i G a Notary Public of the County of +�" `� State
of North Carolina hereby certify that ��� %� personally appeared before me this
day and under oath acknowledged that the above form was executed by him/her
/I day of / Z `/� / 90 9��.
Notary — My Commission Expires
Witness my ha
# SEAL t
�' ��`'•avB�"•�"'°.�,, as
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Financial responsibility encompasses personal liability by the person signing this disclosure form, it 2 l�rtner in a
partnership or if an officer or director of a corporation which is either: (a) dissolved lawfully under North Carolina statutes:
(b) suspended from transacting business in North Carolina by the North Carolina Secretary of State; (c) insolvent; (d) in
bankruptcy; (e) undercapitalized to the extent it is unable to comply with the Soil Erosion and Sedimentation Control
Ordinance; or (f) a "shell" corporation.
lS
Revised 911912019 Page 2

PART C
Contractors and/or subcontractors (person(s) or firm(s) engaging in the land -disturbing activity):
Name Person or Firm:
Duke Lazzara Development. LLC
Telephone: [phone]
Email:
b:etl dukeiazzara Corn
Current Mailing Address:
4201 Fayetteville Road
Name of Person or Firm:
Telephone:
Email:
Current Mailing Address
City, State, Zip: Race-gn NC 27603 City, State, Zip
The information contained in this form is true and correct to the best of my knowledge and belief was provided by me
while under oath. (This form must be signed by the person or firm engaging in the land -disturbing activity of an
individual or by an officer, director, general partner, attorney -in -fact, or other person with authority to execute
instruments for the entity engaging in the land -disturbing activity if not an individual. I agree to provide corrected
information should there be any change in the information provided herein.
Name:
TerryE Slate Date: � (%' (v ! 2_,,�)ZZ
Title or
Signature:
a Notary Public of the County of a % State of North
Carolina hereby certify that L' 1 K-� DL personally appeared before me this
day and under oath acknowledged atthe above form was executed by him/her, Witness my hand and seal this
-day of 62CtdC� .
Zz
No My Commission Expires
SEAL
Revised 911912019 Page 3

CERTIFICATE OF ASSUMED NAME OR PARTNERSHIP
(SEDIMENTATION POLLUTION CONTROL ACT)
The undersigned, proposing to engage in business in Wake County, North Carolina, under an assumed name or partnership
name, do hereby certify that:
The name under which the business is to be conducted is (insert assumed or partnership name):
The names and residences and mailing addresses of all the owners of the business are (insert name and address of
each owner):
IN WITNESS WHEREOF, this certificate is signed by each of the owners of said business, this
Owner's from above Sign below:
State of North Carolina
County of Wake
a Notary Public, do hereby certify that on this
, personally appeared before me
day of
day of
who are all signers of the foregoing instrument, and each acknowledges the due execution thereof. IN WITNESS
WHEREOF, I have hereunto set my hand and official seal this day of ,
Notary
My Commission Expires
SEAL
Revised 911912019 Page 4

Name of Corporation: Horton Park Investments, LLC
Name of registered agent, street address, mailing address of registered office in Wake County:
Name: Pablo Reiter
Street Address: 6908 North Ridge Drive
City, State, Zip: Raleigh, NC 27615
Current Mailing Address: 6908 North Ridge Drive
City, State, Zip: Raleigh, NC 27615
Enter first, middle, and last name of principal officers.
Enter title and street address of principal officers.
Name and Title:
Name and Title:
Pablo Reiter, Manager
Street Address:
Street Address:
6908 North Ridge Drive
City, State, Zip:
City, State, Zip:
Raleigh, NC 27615
Name and Title:
Name and Title:
Street Address:
Street Address:
City, State, Zip:
City, State, Zip:
Enter first, middle, and last name of directors. Enter title and street address of directors. Attach pages as necessary,
Name and Title:
Name and Title:
Street Address:
Street Address:
City, State, Zip:
City, State, Zip:
Name and Title:
Name and Title:
Street Address:
Street Address:
City, State, Zip:
City, State, Zip:
Revised 911912019 Page 5

SOSID: 2425795
Date Filed: 6/1!2022 1:45:00 PNI
Elaine F. Marshall
State of North Carolina North Carolina Secretary of State
Department of the Secretary of State C2022 146 01190
Limited Liability Company
ARTICLES OF ORGANIZATION
Pursuant to §57D-2-20 of the General Statutes of North Carolina, the undersigned does hereby submit these Articles
of Organization for the purpose of forming a limited liability company.
1. The name of the limited liability company is: Horton Park Investments, LLC
(See Item Iofthe Instructions for appropriate entity designation)
2. The name and address of each person executing these articles of organization is as follows: (State whether each
person is executing these articles of organization in the capacity of a member, organizer or both by checking
all applicable boxes.) Note: This document must be signed by all persons listed.
Name Business Address Capacity
Stephen C. Gambill 2840 Plaza Place, Ste. 400, Raleigh, NC 27612 []Member [jOrganizer
❑Member []Organizer
[]Member ❑Organizer
3. The name of the initial registered agent is: Pablo Reiter
4. The street address and county of the initial registered agent office of the limited liability company is:
Number and street 6908 North Ridge Dr.
City Raleigh
State: NC Zip Code: 27615 count),. Wake
5. The mailing address, if different from the street address, of the initial registered agent office is:
Number and Street
City State: NC Zip Code: County:
6. Principal office information: (Select either a or b.)
a. ❑ The limited liability company has a principal office.
The principal office telephone number:
The street address and county of the principal office of the limited liability company is:
Number and Street:
City: State: Zip Code: County:
BUSINESS REGISTRATION DIVISION P.O. BOX 29622 Raleigh, NC 27626-0622
(Revised August. 201 7) Form L-01

The mailing address, if different from the street address, of the principal office of the company is:
Number and Street:
City: State: Zip Code: County:
b. a The limited liability company does not have a principal office.
7. Any other provisions which the limited liability company elects to include (e.g., the purpose of the entity) are
attached.
8. (Optional): Listing of Company Officials (See instructions on the importance of listing the company officials in the
creation document.
Name Title Business Address
---- --- ----------- --- - -- - - --
Pablo Reiter Manager 6908 North Ridge Dr. Raleigh, NC 27615
9. (Optional): Please provide a business e-mail address:
The Secretary of State's Office will e-mail the business automatically at the address provided above at no cost when a
document is filed. The e-mail provided will not be viewable on the website. For more information on why this service is
offered, please see the instructions for this document.
10. These articles will be effective upon filing, unless a future date is specified:
This is the 26th day of May , 20 2022
Signature
Stephen C. Gambill, Organ zer
Type or Print 'Name and Title
The below space to be used if more than one organizer or member is listed in Item #2 above.
Signature
Type and Print Name and Title
Signature
Type and Print Name and Title
NOTE:
1. Filing fee is $125. This document must be filed with the Secretary of State.
BUSINESS REGISTRATION DIVISION P.O. BOX 29622 Raleigh, NC 27626-0622
(Revised August. 2017) Forni L-01