NCC216183_Contact Update Record (Site Contact)_20230201

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by bethany.georgoulias 2/1/2023 12:44:57 PM (Contact Changes Submitted)

Certificate of NCC216183
Coverage (COC) No.* Enter the Certificate of Coverage Number (Use capital letters)
NC Reference No. NCG01-2021-6183
Original NOI No.* 72455
Project information associated with this permit (cannot change):
Permittee Listed Organizaiton cannot be changed (new COC required)
The Salvation Army
Project Name Salvation Army Center of Hope
Address 45 Ashlyn Drive, Concord, NC
County Cabarrus
Latitude 35.4148
Longitude-80.5740
Date COC Issued * 12/02/2021
Prior Rescission Date This field will populate only if COC has already been rescinded.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 [e-mail]
NEW Billing Email
[e-mail]
Billing Telephone No.
404-728-1300
NEW Billing
[phone]
Telephone No.
(Optional)
Site Contact
(Previous)
Site Contact Title
(Previous)
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Amanda Keaton
Lieutenant

Organization
(Previous)
First Name (New)*
Last Name (New) *
The Salvation Army
Lara
Sassano
NEW Site Contact* Reflects any revisions above
Lara Sassano
NEW Site Contact Lieutenant
Title
NEW Organization The Salvation Army
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 704-782-7822
Telephone No.
(Previous)
NEW Site Contact [phone]
Telephone No.*
Site Contact Mailing 216 Patterson Avenue Southeast, 0,
Address (Previous) Concord, NC 28025-3518
NEW Site Contact Street Address
Mailing Address* 216 Patterson Avenue Southeast
Address Line 2
City
State / Province / Region
Concord
NC
Postal / Zip Code
Country
28025-3518
us
Change Requested Lt. Lara Sassano, Salvation Army of Concord via email between 1/18/2/1/2023.
by: * Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation Officer rotation at the site.
(Optional)
Date * 02/01 /2023