NCC232836_FRO Submitted_20230920

WAKE
COUNTY
NORTH CAROIINA
Slater Road Office Park
Morrisville
Slater/SR1641 35.866481 -78.825659
June 2022
Office
8.0
Joseph Murray, Vice President Construction
Dominion Realty Partners, LLC [e-mail]
919-845-3306 919-369-6766
PR III/DRP Slater Road Office LP
Dominion Realty Partners, LLC 919-845-3306 [e-mail]
501 Fayetteville St., Suite 100 501 Fayetteville St., Suite 100
Raleigh NC 27601 Raleigh NC 27608
019053 02012
Part B.
Chris Carlin°, Chief Operating Officer
Dominion Realty Partners, LLC [e-mail]
501 Fayetteville St., Suite 100 501 Fayetteville St., Suite 100
Raleigh NC 27601 Raleigh NC 27608
919-845-3306

2. (a) If the Financially Responsible Party is not a resident of Wake County, identify a designated agent in
Wake County to receive any notice, process, pleading in any action or legal proceeding arising out of any
matter relating to the Wake County Erosion and Sedimentation Control Ordinance and/or Land
Disturbance Permit:
Chris Carlino, Chief Operating Officer [e-mail]
Dominion Realty Partners, LLC
Name E-mail Address
501 Fayetteville St., Suite 100 501 Fayetteville St., Suite 100
Current Mailing Address Current Street Address
Raleigh NC 27608 Raleigh NC 27608
City State Zip City State Zip
Telephone [phone] Fax Number
(b) 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:
Alexander Andrews, IV [e-mail]
Name of Registered Agent E-mail Address
501 Fayetteville St. Suite 100
Current Mailing Address Current Street Address
Raleigh NC 27608
City State Zip City State Zip
Telephone [phone] Fax Number
The above information is true 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
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.
Chris Carlino Chief Operating Officer, Dominion Realty Partners, LLC
Type r rint name Title or Authority
/3/23
Signature Date
! cv C. ask,,0 , a Notary Public of the County of V\R,�e
State of North Carolina, hereby certify that C�(:$ Cwt.\ ke..0 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, th•
is \r) day of. 20 a0_31f
NOT
i�y 'A' Notary
F. Seal O= e 1 \ (���
My commission expires a� d-
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