NCC231095_FRO Submitted (3)_20230419

(c) lf the Financially Responsible Party is engaging in business under an assumed name, give name under
whicti the company is Doing Business As. If the Financiatry F`esponsit]te Party is an individual, General
Partnership, or other company not registered and doing business under an assumed name, attach a copy
of the Certificate of Assumed Name.
Company DBA Name
The above infomiafron is tr\je and correct to the best 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(s)
or his attomeyiniact: or if not an individual, by an officer, director, partner, or registered agent with
the authority to execute instruments for the Financially Responsible Party). I agree to provide
corrected infomation should there be any change in the information provided herein.
April Whitehurst Haltigan President
State Of NiorF_ Carolina] hereby certify that
before me this day and being duly sworn a
aNotarypublicofthecountyofBfjc®,`u_a.r+