NCC213764_Contact Update Record (Billing)_20230707

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by bethany.georgoulias 7/7/2023 7:56:01 AM(Contact Changes Submitted)

Contact • - for • • • ONLY)
updatesThis form • . .
Certificate of NCC213764
Coverage(COC) No.* Enter the Certificate of Coverage Number(Use capital letters)
NC Reference No. NCG01-2021-3764
Original NOI No.* 56981
Project information associated with this permit(cannot change):
Permittee Listed Organizaiton cannot be changed(new COC required)
Dream Finders Homes, LLC
Project Name Medlin Forest Subdivision
Address 1298 Medlin Road, Monroe, NC
County Union
Latitude 34.9653
Longitude -80.5260
Date COC Issued* 07/14/2021
Prior Rescission Date This field will populate only if COC has already been rescinded.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? Q No
0 Yes
Billing Email [e-mail]
NEW Billing Email [e-mail]
Billing Telephone No. [phone]
NEW Billing [phone]
Telephone No. (Optional)
Change Requested John Osinga via email on 7/7/2023.
by:* Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date* 07/07/2023