NCC224093_FRO Submitted_20221213

PART B. FINANCIALLY RESPONSIBLE OWNER (FRO)/PERSONS INFORMATION
1. PERSON(S) OR FIRMS WHO ARE FINANCIALLY RESPONSIBLE FOR THE LAND -DISTURBING ACTIVITY (PROVIDE A
COMPREHENSIVE LIST OF ALL RESPONSIBLE PARTIES ON AN ATTACHED SHEET):
Tri Pointe Homes Holdings, Inc [e-mail]
NAME EMAIL
1330 Sunday Drive, Suite 101
ADDRESS
Raleigh NC 27607
CITY STATE ZIP CODE
919-675-8822
PHONE CELL
2. IF THE FINANCIALLY RESPONSIBLE PARTY IS NOT A RESIDENT OF NORTH CAROLINA, GIVE NAME AND STREET ADDRESS OF
THE DESIGNATED NORTH CAROLINA AGENT:
NAME EMAIL
ADDRESS
CITY
STATE ZIP CODE
PHONE CELL
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 PARTY IS A CORPORATION, GIVE NAME AND STREET ADDRESS OF THE REGISTERED AGENT:
NAME OF REGISTERED AGENT
ADDRESS
CITY STATE ZIP
E-MAIL ADDRESS

PHONE
FAX
The above information is true and correct to the Kest 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 the authority to execute instruments for the Financially Responsible
Person). I agree to provide corrected information should there be any change in the information
provided herein.
Bob Davenport
NAME
SIGNATURE
Division President
TITLE OR AUTHORITY
3-1Y.
DATE
a Notary Public of the County of
wc'V-e— , State of North Carolina, hereby certify that
tzob'-' appeared personally before me this day and being
duly sworn acknowledged that the above form was executed by him.
Witness my hand and notarial seal, this �day of Mc P'C-L'A 20 22-
Notary
My commission expires to (e Z0z('