NCC210135_Contact Update Record (Address Only)_20230126

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Georgoulias, Bethany A 1/26/2023 8:15:39 AM (Contact Changes Submitted)

Certificate of NCC210135
Coverage (COC) No.* Enter the Certificate of Coverage Number (Use capital letters)
NC Reference No. NCG01-2021-0135
Original NOI No.* 40524
Project information associated with this permit (cannot change):
Permittee Listed Organizaiton cannot be changed (new COC required)
DGT Ventures, LLC
Project Name DGT Ventures, LLC
Address 5000 US HWY 70E, New Bern, NC
County Craven
Latitude 35.0057
Longitude-76.9892
Date COC Issued * 01 /11 /2021
Prior Rescission Date This field will populate only if COC has already been rescinded.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 Dustin Tyson
Individual (Previous)
First Name (New)* Dustin
Last Name (New) * Tyson

NEW Legally
Reflects any revisions above
Responsible
Dustin Tyson
Individual*
Permittee Email
[e-mail]
(Previous)
NEW Permittee
[e-mail]
Email*
Permittee Telephone
252-633-4411
No. (Previous)
NEW Permittee
[phone]
Telephone No.*
Permittee Mailing
1601 HWY 70 E, 0, New Bern, NC 28560
Address (Previous)
NEW Permittee
Street Address
Mailing Address*
P.O. Box 3501
Address Line 2
City
New Bern
Postal / Zip Code
28564
Permittee Street
1601 HWY 70 E, 0, New Bern, NC 28560
Address (Previous)
NEW Permittee Street
Street Address
Address*
P.O. Box 3501
Address Line 2
State / Province / Region
NC
Country
us
City
State / Province / Region
New Bern
NC
Postal / Zip Code
Country
28564
us
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact Dustin Tyson
(Previous)
Site Contact Title
Owner
(Previous)
Organization
(Previous)
First Name (New)*
Dustin
Last Name (New) *
Tyson
NEW Site Contact*
Reflects any revisions above
Dustin Tyson

NEW Site Contact Owner
Title
NEW Organization DGT Ventures, LLC
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 252-633-4411
Telephone No.
(Previous)
NEW Site Contact [phone]
Telephone No.*
Site Contact Mailing 1601 HWY 70E, 0, New Bern, NC 28560
Address (Previous)
NEW Site Contact Street Address
Mailing Address* P.O. Box 3501
Address Line 2
City
New Bern
Postal / Zip Code
28564
State / Province / Region
NC
Country
us
Change Requested Note on invoice when returned with payment (see file for scan).
by: * Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date * 01 /26/2023