NCC230123_Contact Update Record (Billing)_20240222

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by bethany.georgoulias 2/22/2024 8:12:10 AM (Contact Changes Submitted)

Contact • - for • • • ONLY)
updatesThis form • . .
Certificate of NCC230123
Coverage(COC) No.* Enter the Certificate of Coverage Number(Use capital letters)
NC Reference No. NCG01-2023-0123
Original NOI No.* 122602
Project information associated with this permit(cannot change):
Permittee Listed Organizaiton cannot be changed(new COC required)
Two Farms, Inc.
Project Name Royal Farms-Store#493
Address MLK Blvd.and NC 33 East,Greenville, NC
County Pitt
Latitude 35.6267
Longitude -77.3303
Date COC Issued* 01/17/2023
Prior Rescission Date This field will populate only if COC has already been rescinded.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. 410-371-9580
NEW Billing [phone]
Telephone No. (Optional)
Change Requested Samantha Kruger(Ratcliffe Architects)via email on 2/16/2024.
by:* Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date* 02/22/2024